Prevention of arterial spasm during percutaneous coronary interventions through radial artery: The SPASM study

Varenne, Olivier; Jégou, Arnaud; Cohen, R.; Empana, Jean Philippe; Salengro, Emmanuel; Ohanessian, Alice; Gaultier, C; Allouch, Philippe; Walspurger, Sylvie; Margot, Olivier; Hallack, Abdel El; Jouven, Xavier; Weber, Simon; Spaulding, Christian

doi:10.1002/ccd.20812

Cited by 115 publications

(68 citation statements)

References 16 publications

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“…Apesar de se tratar de um registro, os resultados foram corroborados pela ausência de diferenças entre os grupos nas principais características basais (idade, porcentagem de mulheres, peso e altura), sendo pacientes mais jovens, sexo feminino, diabetes melito e baixo peso corporal considerados preditores de espasmo da artéria radial em vários estudos. [12][13][14] Semelhante à técnica femoral, a abordagem radial necessita de um período de aprendizado provavelmente mais longo. 15,16 O material utilizado nesse acesso teve melhora gradual em relação à redução do tamanho dos cateteres, desenho de novas curvas adaptadas à técnica radial e prevenção de espasmo.…”

Section: Discussionunclassified

Comparação entre um cateter único dedicado e cateteres de Judkins na realização da cineangiocoronariografia pela via radial direita

Tebet¹,

Andrade²,

Andrade³

et al. 2010

Rev. Bras. Cardiol. Invasiva

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RESUMOIntrodução: O espasmo radial é considerado um dos principais fatores de insucesso na via radial. O tempo prolongado de exame, a utilização de cateteres de maior diâme-tro, as fricções do cateter durante a manipulação e o número de cateteres utilizados estão entre as principais causas. A utilização de cateteres únicos dedicados a esse acesso poderia minimizar tais fatores, com consequente diminuição da incidência de espasmo. Método: Registro prospectivo de pacientes consecutivos com suspeita de doença coronária, submetidos a coronariografia pelo acesso radial direito, com introdutores 5 F. (grupo I) foram incluídos e comparados a um grupo controle com mesmo número de pacientes, que utilizaram cateteres de Judkins (grupo II). Houve maior taxa de sucesso do procedimento no grupo I (100% vs. 98%; P = 0,03) e não houve diferença na taxa de sucesso da estratégia escolhida (93,7% vs. 95%; P = 0,59). Houve diminuição estatisticamente significante da duração do procedimento (13,6 + 6 min vs. 15 + 6,4 min; P = 0,007), do tempo de fluoroscopia (2,5 + 1,6 min vs. 3,1 + 2,2 min; P = 0,0009) e do número de cateteres (1,1 + 0,3 vs. 2,1 + 0,6; P < 0,0001) no grupo I. Não houve diferença na ocorrên-cia de espasmo (4,7% vs. 5,7%; P > 0,99). Conclusão: A utilização de cateter dedicado ao acesso radial mostrouse eficaz, segura, com diminuição significativa do tempo de fluoroscopia, do exame e do número de cateteres, com ABSTRACT Comparison of a Single Dedicated Catheter and the Judkins Catheter for Coronary Angiography Using the Right Transradial AccessBackground: Radial spasm is considered one of the main reasons of failure in the transradial approach. The prolonged procedure time, use of large diameter catheters, catheter frictions during manipulation and number of catheters used are among the main causes of radial spasm. The use of catheters dedicated to radial access could minimize such factors, with a consequent reduction in the incidence of spasm. Method: Prospective registry of consecutive patients with suspected coronary artery disease undergoing coronary angiography using the right radial access, with 5 F sheaths. We compared the procedural success, the strategy success, duration of the procedure, fluoroscopy time and the number of catheters used among patients who used the dedicated catheter (Optitorque TM TIG) with those using the Judkins catheter (JL/JR). Results: From September 2009 to July 2010, 300 patients using the dedicated catheter (group I) were included and compared with a control group with the same number of patients whose procedure was performed using Judkins catheters (group II). There was a higher procedure success rate in group I (100% vs. 98%; P = 0.03) and no difference in the chosen strategy success (93.7% vs. 95%; P = 0.59). There was a statistically significant decrease in the duration of the procedure (13.6 + 6 min vs. 15 + 6.4 min; P = 0.007), in fluoroscopy time (2.5 + 1.6 min vs. 3.1 + 2.2 min; P = 0.0009) and number of catheters (1.1 + 0.3 vs. 2.1 + 0.6 min; P < 0.0001) in group I. There...

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Section: Discussionunclassified

Comparação entre um cateter único dedicado e cateteres de Judkins na realização da cineangiocoronariografia pela via radial direita

Tebet¹,

Andrade²,

Andrade³

et al. 2010

Rev. Bras. Cardiol. Invasiva

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“…Several RAS-associated factors have been identified including patient-related factors (female gender, young age, low body mass index, short stature, small radial artery diameter, diabetes mellitus, dyslipidaemia, anxiety, anomalous radial artery) and technical factors (low radial-artery-to-sheath ratio, non-hydrophilic coated sheaths, unsuccessful access at first attempt, prolonged cannulation, multiple catheter exchanges, excessive catheter manipulations, limited operator experience) [8,[15][16][17][18][19][20][21]. In the present study, radial artery pulse grading, which was found to be correlated with radial artery diameter, female sex, and larger catheter size were demonstrated as predictors of RAS.…”

Section: Discussionmentioning

confidence: 99%

“…Many preventive measures have been suggested to prevent spasm of the radial artery such as sedation, adequate analgesia, hydrophilic coated sheaths, and intra-arterial vasodilators [7,8,17]. Various drugs have been extensively evaluated to prevent spasm of radial artery, but there is currently no agreement on the optimal agents.…”

Section: Discussionmentioning

confidence: 99%

“…Various drugs have been extensively evaluated to prevent spasm of radial artery, but there is currently no agreement on the optimal agents. The majority of previous reports advocated the use of intra-arterial vasodilators, most frequently verapamil and/or nitrogylcerin [7,8,17,18]. In a head-to-head comparison study between nitroglycerin and verapamil there was no statistically significant difference in the ACEI -angiotensin converting enzyme inhibitor; BP -blood pressure; HDL-C -high-density lipoprotein-cholesterol; LDL-C -low-density lipoprotein-cholesterol; RAS -radial artery spasm incidence of RAS [22].…”

Section: Discussionmentioning

confidence: 99%

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Can radial artery pulse grading predict radial artery spasm during transradial approach?

Zencirci

Değirmencioğlu

2017

Kardiol Pol

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A b s t r a c tBackground: Radial artery spasm (RAS) has been defined as one of the major disadvantage of transradial approach. Aim:The aim of this study was to investigate the predictive value of radial artery pulse grading on RAS during transradial approach. Methods:The present study prospectively included 115 consecutive patients who underwent transradial coronary catheterisation at a single centre. Patients were divided into two groups: those with RAS and those without. Results:The incidence of RAS was 16.5% (n = 19). Multivariate logistic regression analysis demonstrated that female sex, guiding catheter usage, and radial artery pulse grading ≤ 2 independently predicted RAS (odds ratio [OR] 8, 95% confidence interval [CI] 1.8-36.2, p = 0.007, OR 10.6, 95% CI 2.2-51.2, p = 0.03 and OR 25.8, 95% CI 6.1-108.5, p < 0.001, respectively). These three variables were weighted proportionally to their respective OR for RAS (female sex [1.5 points], guiding catheter usage [2 points], and radial artery pulse grading ≤ 2 [5 points]). Two risk strata were defined (low risk, score 0-4, high risk, score 5-8.5), and high risk was associated with increased incidence of RAS (n = 13 [61.9%] vs. n = 6 [6.4%], p < 0.001). Conclusions:Radial artery pulse grading together with female sex and guiding catheter usage are independent predictors of RAS, and by using a simple risk score high-risk patients for RAS can be identified.

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“…In addition to premedication and local anaesthesia, intraarterial administration of vasodilatators is essential. Various spasmolytic cocktails have been tried [5]. Verapamil is the most commonly used vasodilatator, being administered directly after sheath insertion in a dose of 2.5 up to 5.0 mg (diluted up to 10 ml with saline).…”

Section: Sheath Sizementioning

confidence: 99%

How to transform you into a radialist (Part II): tips and tricks

Frangos¹,

Noble²

2011

Cardiovasc Med

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SummaryThe transradial approach increases patient comfort and reduces vascular complications and major bleeding. Although modern equipment has been improved and catheter sizes reduced, there remain specific technical challenges in the practice of the transradial approach. Indeed, the transradial approach requires a longer learning curve than transfemoral access, but the transradial challenges are usually overcome with experience. Nowadays, in view of its benefits, there is no longer any justification for ignoring the transradial approach, the patient's preferred access route for percutaneous coronary interventions. In this paper we highlight five rules which will transform you into a radialist and provide valuable tips and tricks.

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Prevention of arterial spasm during percutaneous coronary interventions through radial artery: The SPASM study

Cited by 115 publications

References 16 publications

Comparação entre um cateter único dedicado e cateteres de Judkins na realização da cineangiocoronariografia pela via radial direita

Comparação entre um cateter único dedicado e cateteres de Judkins na realização da cineangiocoronariografia pela via radial direita

Can radial artery pulse grading predict radial artery spasm during transradial approach?

How to transform you into a radialist (Part II): tips and tricks

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