The effect of pre-procedure sublingual nitroglycerin on radial artery diameter and Allen's test outcome - Relevance to transradial catheterization

Chong, Aun‐Yeong; Lo, Ted; George, Sudhakar; Ratib, Karim; Mamas, Mamas A.; Nolan, James

doi:10.1016/j.carrev.2017.07.016

Cited by 20 publications

(13 citation statements)

References 24 publications

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“…Our results further support the importance of reducing occlusive compression and hemostasis time in populations at increased risk of RAO such as Japanese patients, especially when using larger sheath sizes. In non‐Japanese patients, we found the opposite in that the GSS6Fr had similar clinical outcomes to that of a standard 5 Fr sheath, including a similar rate of RAO, that may be related to the combination of shorter hemostasis time and potentially larger radial artery diameters .…”

Section: Discussionmentioning

confidence: 71%

Impact of sheath size and hemostasis time on radial artery patency after transradial coronary angiography and intervention in Japanese and non‐Japanese patients: A substudy from RAP and BEAT (Radial Artery Patency and Bleeding, Efficacy, Adverse evenT) randomized multicenter trial

Aminian

Saïto

Takahashi

et al. 2018

Cathet Cardio Intervent

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Section: Discussionmentioning

confidence: 71%

Impact of sheath size and hemostasis time on radial artery patency after transradial coronary angiography and intervention in Japanese and non‐Japanese patients: A substudy from RAP and BEAT (Radial Artery Patency and Bleeding, Efficacy, Adverse evenT) randomized multicenter trial

Aminian

Saïto

Takahashi

et al. 2018

Cathet Cardio Intervent

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“…Radial artery manipulation, especially in patients with smaller artery size, damages the intima and media, and leads to vessel stenosis and RAS. 13 The study by Kiemeneij et al showed that the administration of verapamil (5 mg)+nitroglycerin (200 μg) did not differ significantly from no-vasodilator group in terms of radial artery diameter (P-value=0.79). 24 In the present study, the mean size of the radial artery dramatically increased in the labetalol group compared to nitroglycerin immediately after intra-arterial injection (2.24±0.58mm vs. 1.65±0.39mm, P-value<0.001) (Table 2).…”

Section: Discussionmentioning

confidence: 94%

“…[9][10][11] Nitroglycerin is one of the medications that its beneficial effect on RAS, radial diameter increase, and pain relief has been proven in many studies. 1,9,12,13 Nitroglycerin is a vasodilator which releases NO, stimulates the activity of guanylate cyclase and cGMP leading to relaxation of smooth muscles of the vessels. 14 Nitroglycerin relieves the spasm induced from various pathways such as thromboxane A2, endothelin and α-adrenoreceptors.…”

Section: Introductionmentioning

confidence: 99%

Intra-Arterial Labetalol and Nitroglycerin in Preventing Radial Artery Spasm Following Transradial Angiography: A New Approach

et al. 2020

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Background: Radial artery spasm (RAS) resulted from decreasing blood flow and activation of vasomotor system leads to a decrease in artery diameter, perfusion and patency, and increase the risk of procedure failure. In this study, we investigated the effects of intra-arterial administration of nitroglycerin and labetalol on radial artery diameter, RAS, and pain intensity in patients undergoing diagnostic radial angiography. Methods: Sixty-four patients randomly enrolled into one of the nitroglycerin (150 μg) or labetalol (500 μg) groups. The radial artery size, and the incidence of RAS were measured before, immediately after puncture, and at the end of treatment. Pain intensity was evaluated using a visual-analog-scale (VAS) at the end of the procedure. Hemodynamic status before, and during the procedure was also recorded. Results: Labetalol causes a significantly larger increase in radial diameter than nitroglycerin immediately after intra-arterial injection (2.24±0.58 mm vs. 1.65±0.39 mm, P-value<0.001). The rate of RAS immediately after vasodilator administration in the labetalol group was 3.1% vs. 12.5% in the nitroglycerin group (P-value=0.355), but the overall incidence (immediately after administration+ at the end of procedure) did not show a statistically significant difference (53.125% vs 31.25% respectively, P-value=0.076). The VAS score did not show a significant difference between two groups (1.15±0.44 in nitroglycerin vs. 1.50±0.91, P-value=0.063). Conclusion: Labetalol increases radial artery diameter more than nitroglycerin. However, the efficacy of labetalol in terms of RAS incidence, and patients’ pain was similar to nitroglycerin. Therefore, intra-arterial labetalol could be considered as one of the therapeutic options in clinical practice in order to reduce RAS and procedure failure.

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“…Next, the average diameter of the radial artery is 1.7–2.8 mm and in many patients the diameter of the radial artery can be equal to or smaller than a 6 Fr sheath. High sheath‐to‐artery ratio is a known risk factor for radial artery occlusion .…”

Section: Discussionmentioning

confidence: 99%

Contemporary transradial access practices: Results of the second international survey

Shroff

Fernandez

Vidovich

et al. 2018

Cathet Cardio Intervent

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Objectives To gain insight into current practice of transradial angiography and intervention in the United States and around the world. Background Transradial access (TRA) has grown worldwide. In a prior survey, there was significant practice variation and there was minimal US participation which limited the generalizability to US operators. Methods We used an internet‐based survey software program to solicit input from practicing interventional cardiologists from the United States and around the world. US operators were compared with outside the United States (OUS) operators and respondent‐level comparisons were made with the prior survey to assess for temporal changes in practice. Results Between August 2016 and January 1, 2017, 125 interventional cardiologists completed the survey representing 91 countries with the United States having 449 (39.9%) respondents. Preprocedure, noninvasive testing for collateral circulation is used more commonly in the United States (54.1%) than around the world (26.6%) but its use has decreased since 2010. In the US, 48.8% of operators never use ultrasound and 92.6% of OUS operators never use it; only 4.4% overall use ultrasound in >50% of cases. Use of bivalirudin has decreased in the US and OUS. Nearly, 30% of operators do not assess for radial artery patency following hemostasis. US respondents used TRA less commonly for primary PCI for STEMI than their global counterparts. Conclusions There is wide variation in how TRA procedures are performed including relatively low rates of adherence to practices that are known to improve outcomes. Further education aimed at increasing use of best practices will impact patient outcomes.

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The effect of pre-procedure sublingual nitroglycerin on radial artery diameter and Allen's test outcome - Relevance to transradial catheterization

Cited by 20 publications

References 24 publications

Impact of sheath size and hemostasis time on radial artery patency after transradial coronary angiography and intervention in Japanese and non‐Japanese patients: A substudy from RAP and BEAT (Radial Artery Patency and Bleeding, Efficacy, Adverse evenT) randomized multicenter trial

Impact of sheath size and hemostasis time on radial artery patency after transradial coronary angiography and intervention in Japanese and non‐Japanese patients: A substudy from RAP and BEAT (Radial Artery Patency and Bleeding, Efficacy, Adverse evenT) randomized multicenter trial

Intra-Arterial Labetalol and Nitroglycerin in Preventing Radial Artery Spasm Following Transradial Angiography: A New Approach

Contemporary transradial access practices: Results of the second international survey

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