Radial artery spasm: Should we worry?

Backman, Steven B.

doi:10.1007/s12630-017-0946-5

Cited by 7 publications

(7 citation statements)

References 20 publications

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“…Hypotension is a well-known side effect of the medications routinely used for moderate sedation (Midazolam and Fentanyl) and those used to maintain radial artery patency and prevent spasm during transradial procedures (Nitroglycerin and Verapamil). 5,6,8 At this time, studies specifically evaluating the hemodynamic effects of intra-arterial administration of vasodilators are limited. This is the first study to evaluate the combined effect of both vasodilators and moderate sedation.…”

Section: Discussionmentioning

confidence: 99%

“…1 Radial artery spasm (RAS), which has been reported to occur at rates as high as 12%-30%, continues to pose a significant obstacle to operators and results in patient discomfort, increased procedural times, higher rates of radial artery occlusion, and higher femoral artery conversion rates. [1][2][3][4][5] Radial artery spasm is known to occur less frequently with experienced operators and proper patient preparation. 1 Though there are many strategies for reducing RAS during TRA, attempts at reducing the incidence of RAS have been most successful with the administration of intra-arterial vasodilators.…”

Section: Introductionmentioning

confidence: 99%

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Effect of intra-arterial vasodilator administration during radial artery access on systemic blood pressure in patients receiving moderate sedation

et al. 2021

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Purpose: The hemodynamic effects of intra-arterial vasodilator administration for the prevention of radial artery spasm during transradial access have not been well characterized. This study evaluates the effect of intra-arterial Verapamil and Nitroglycerine administration on systemic blood pressure and its correlation with timing of moderate sedation administration. Materials and methods: Institutional review board approval was granted. Patients who underwent transradial access from 4/2018 to 4/2019 and received both intra-arterial vasodilators and moderate sedation were identified and their electronic medical records reviewed. Patients were divided into three cohorts based on the timing of sedation and intra-arterial vasodilator administration. Decrease in systolic blood pressure (SBP) was expressed as means with standard deviation which were then compared using Student’s t-test. Results: A total of 84 patients who met inclusion criteria demonstrated an overall mean decrease in SBP of 16.45 mmHg ± 15.45 mmHg. Patients receiving sedation and intra-arterial vasodilators within their expected peak SBP effect times had similar SBP change following the intra-arterial vasodilators as those in whom the interval was greater than 10 min (4.2 mmHg; 95% CI (−4.11 to 12.52), p = 0.3171). Two patients experienced asymptomatic hypotension. Conclusions: Patients undergoing transradial access for procedures utilizing moderate sedation can safely receive intra-arterial Verapamil and Nitroglycerine for prevention of radial artery spasm.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of intra-arterial vasodilator administration during radial artery access on systemic blood pressure in patients receiving moderate sedation

et al. 2021

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“…Indeed, transradial artery cardiac catheterization has become a mainstay for angiography, and although generally very safe, it does have known complications, albeit rare, that include difficult removal of the angiography catheter. 2 Entrapment of the catheter is thought to be related to sympathetic mediated vasospasm, 3 and as Fitzgerald reported, entrapment can be refractory to even rigorous manual attempts at removal. Similar vasospasm of the radial artery has been reported as the cause of dampening of invasive blood pressure monitors that is a relatively more frequent occurrence.…”

Section: An Alternate Approach To the Entrapped Transradial Cathetermentioning

confidence: 99%

An Alternate Approach to the Entrapped Transradial Catheter

Grocott

2018

Regional Anesthesia and Pain Medicine

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“…It is well known that the radial artery has a higher sensitivity to spasm compared with other arteries. [ 9 ] RAS can be caused by the circulating catecholamines stimulating the alpha-1 adrenoreceptors that contract smooth muscle cells of the radial artery. [ 10 ]…”

Section: Introductionmentioning

confidence: 99%

Effect of vasodilatory medications on blood pressure in patients undergoing transradial coronary angiography: A comparative study

et al. 2020

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Background: In patients undergoing coronary intervention, different vasodilators are used to prevent the radial artery spasm (RAS). To date, no studies investigated the effect of these vasodilators in blood pressure (BP) reduction. Aim: The study aimed to investigate and compare the effect of vasodilatory medications on BP reduction in patients undergoing transradial coronary angiography procedure. Methods: We consecutively included 300 patients undergoing transradial coronary angiography procedures and randomly assigned them into three equal groups to compare the effect of verapamil (2.5 mg), nitroglycerin (200 μg), and combination (verapamil 2.5 mg with nitroglycerin 200 (μg) was diluted in 5 ml of normal saline and given through radial sheath. Changes in the BP, heart rate (HR), and other clinical parameters were assessed and presented as standardized mean differences (SMD) with 95% confidence intervals (CIs). ANOVA test was performed to analyze the differences in the BP and other clinical parameters between the three groups. Results: Overall, the mean age of the study population was 53.26 years (standard deviation: 9.27), male patients (84%), with dyslipidemia (62.6%), and diabetes (45%). At baseline, the mean systolic BP (SBP) was 150.91 ± 31.66 mmHg, HR (72.34 ± 12.71 beats/min). After the administration of vasodilators, the combination group reduced SBP significantly (SMD: −33.35 [95% CI]: −40.27–−26.42, P < 0.001). There was a statistically significant difference between groups for the SBP ( F [2,296] =3.38, P = 0.035). Verapamil alone showed a significant decrease in the SBP by −27.23 mmHg and diastolic BP by −4.980 mmHg. Conclusion: Intra-arterial administration of verapamil alone showed lower BP reduction compared to the combination of vasodilators. Verapamil could be a safer and effective alternative to prevent RAS with no deleterious effect on BP and HR in patients undergoing transradial coronary angiography.

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Radial artery spasm: Should we worry?

Cited by 7 publications

References 20 publications

Effect of intra-arterial vasodilator administration during radial artery access on systemic blood pressure in patients receiving moderate sedation

Effect of intra-arterial vasodilator administration during radial artery access on systemic blood pressure in patients receiving moderate sedation

An Alternate Approach to the Entrapped Transradial Catheter

Effect of vasodilatory medications on blood pressure in patients undergoing transradial coronary angiography: A comparative study

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