The efficacy of nitroglycerin to prevent radial artery spasm and occlusion during and after transradial catheterization: A systematic review and meta‐analysis of randomized controlled trials

Abdelazeem, Basel; Abuelazm, Mohamed; Swed, Sarya; Gamal, Mohamed; Atef, Mostafa; Al‐Zeftawy, Mohamed A.; Noori, Muhammad Atif Masood; Lutz, Anthony; Volgman, Annabelle Santos

doi:10.1002/clc.23906

Cited by 10 publications

(3 citation statements)

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“…To the contrary, a recent systematic review by Abdelazeem et al denied the efficacy of both intraarterial and topical nitroglycerin in spasm prevention. Nevertheless, it was stated that subcutaneous nitroglycerin administration is an effective method of prevention [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Radial artery spasms – angiographic morphology, risk factors and management

Roczniak,

Tarnawski,

Dziewierz

et al. 2024

pwki

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Introduction Radial artery is the preferred access for coronary interventions. However, the procedure is sometimes interrupted by a spasm which causes pain, prolongs the procedure, and can force the access crossover. Aim To observe factors contributing to a symptomatic radial artery spasm. Material and methods In this prospective study, we present results of 103 consecutive patients regarding radial artery spasm and angiographic image of the punctured artery. Angiography of the radial artery was performed in 70 (68.0%) patients. Potential risk factors for radial artery spasm were evaluated. Results The overall incidence of the radial artery spasm was high – 25 (24.3%). Signs of spasm were present in 37.1% of radial artery angiographies before the procedure and 60.1% after, however, it did not always indicate a symptomatic spasm. Risk factors related to radial artery spasm included female sex (OR = 2.94, p = 0.02), failure of the first puncture attempt (OR = 3.12, p = 0.014) and use of non-hydrophilic sheath (OR = 9.56, p = 0.036). Radial artery narrowing at the tip of the sheath was also a risk factor for spasm ( p = 0.022). No spasms were observed after hydrophilic sheath application ( n = 13). The administration of a radial cocktail was not observed to significantly decrease the spasm odds. Conclusions Risk factors for radial artery spasm include female sex and multiple puncture attempts. Hydrophilic sheath coating protects against radial artery spasm. Overall signs of a spasm in the angiography are common and do not imply a symptomatic spasm, which can be predicted by a tight narrowing at the tip of the sheath.

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Section: Discussionmentioning

confidence: 99%

Radial artery spasms – angiographic morphology, risk factors and management

Roczniak,

Tarnawski,

Dziewierz

et al. 2024

pwki

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“… Radial artery vasodilators: Nitroglycerin is a vasodilating agent and is traditionally used intra-arterially during transradial catheterization to prevent radial artery spasms, usually at a dose of 200–500 μg. However, in the latest randomized study and the latest meta-analysis, intra-arterial nitroglycerin did not show any advantage in preventing radial artery spasms or RAO [ 54 , 55 ]. Only subcutaneous nitroglycerin was found to prevent radial spasms or RAO [ 55 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, in the latest randomized study and the latest meta-analysis, intra-arterial nitroglycerin did not show any advantage in preventing radial artery spasms or RAO [ 54 , 55 ]. Only subcutaneous nitroglycerin was found to prevent radial spasms or RAO [ 55 ]. Verapamil, a calcium channel blocker, is also used intra-arterially as a vasodilator during transradial catheterization, at a dose of 2.5–5 mg.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Prognostic Factors of Radial Artery Occlusion in Transradial Coronary Catheterization

Didagelos,

Pagiantza,

Papazoglou

et al. 2024

JCM

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Background/Objectives: Radial artery occlusion (RAO) is the most common complication of transradial coronary catheterization. In this study, we aimed to evaluate the incidence of RAO and identify the risk factors that predispose patients to it. Methods: We conducted an investigator-initiated, prospective, multicenter, open-label study involving 1357 patients who underwent cardiac catheterization via the transradial route for angiography and/or a percutaneous coronary intervention (PCI). Univariate and multivariate logistic regression analyses were performed to identify potential predictors of RAO occurrence. Additionally, a subgroup analysis only for patients undergoing PCIs was performed. Results: The incidence of RAO was 9.5% overall, 10.6% in the angiography-only group and 6.2% in the PCI group. Independent predictors of RAO were as follows: (i) the female gender (aOR = 1.72 (1.05–2.83)), (ii) access site cross-over (aOR = 4.33 (1.02–18.39)), (iii) increased total time of the sheath in the artery (aOR = 1.01 (1.00–1.02)), (iv) radial artery spasms (aOR = 2.47 (1.40–4.36)), (v) the presence of a hematoma (aOR = 2.28 (1.28–4.06)), (vi) post-catheterization dabigatran use (aOR = 5.15 (1.29–20.55)), (vii) manual hemostasis (aOR = 1.94 (1.01–3.72)) and (viii) numbness at radial artery ultrasound (aOR = 8.25 (1.70–40)). Contrariwise, two variables were independently associated with increased odds for radial artery patency (RAP): (i) PCI performance (aOR = 0.19 (0.06–0.63)), and (ii) a higher dosage of intravenous heparin per patient weight (aOR = 0.98 (0.96–0.99)), particularly, a dosage of >50 IU/kg (aOR = 0.56 (0.31–1.00)). In the PCI subgroup, independent predictors of RAO were as follows: (i) radial artery spasms (aOR = 4.48 (1.42–14.16)), (ii) the use of intra-arterial nitroglycerin as a vasodilator (aOR = 7.40 (1.67–32.79)) and (iii) the presence of symptoms at echo (aOR = 3.80 (1.46–9.87)), either pain (aOR = 2.93 (1.05–8.15)) or numbness (aOR = 4.66 (1.17–18.57)). On the other hand, the use of intra-arterial verapamil as a vasodilator (aOR = 0.17 (0.04–0.76)) was independently associated with a greater frequency of RAP. Conclusions: The incidence of RAO in an unselected, all-comers European population after transradial coronary catheterization for angiography and/or PCIs is similar to that reported in the international literature. Several RAO prognostic factors have been confirmed, and new ones are described. The female gender, radial artery trauma and manual hemostasis are the strongest predictors of RAO. Our results could help in the future identification of patients at higher risk of RAO, for whom less invasive diagnostic procedures maybe preferred, if possible.

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The efficacy of nitroglycerin to prevent radial artery spasm and occlusion during and after transradial catheterization: A systematic review and meta‐analysis of randomized controlled trials

Abdelazeem

Abuelazm

Swed

et al. 2022

Clinical Cardiology

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Radial artery spasm (RAS) is the most common cause of transradial access site crossover and is a common intra‐procedural complication. RAS incidence can lead to radial artery occlusion (RAO) postprocedure, preventing the radial artery as a future access site. We evaluated the efficacy of nitroglycerin preventing RAS and RAO during transradial catheterization discussing the different routes of administration, including topical, subcutaneous, and intra‐arterial. A systematic review and meta‐analysis included all relevant articles until April 23, 2022. We searched six databases Google Scholar, Web of Science, SCOPUS, EMBASE, PubMed (MEDLINE), and CENTRAL. We registered our review protocol in PROSPERO with ID: CRD42022330356. We included 11 trials with 5814 patients. Compared to placebo, the pooled analysis favored subcutaneous nitroglycerin in preventing RAS (risk ratio [RR]: 0.57 with 95% confidence interval [CI] [0.43–0.77], p = .0003) and RAO (RR: 0.39 with 95% CI [0.16–0.98], p = .05). In contrast to the intra‐arterial nitroglycerin that showed nonstatistically significant results in preventing RAS and RAO (RR: 0.8 with 95% CI [0.63–1.02], p = .07)‐ (RR: 0.78 with 95% CI [0.6–1.01], p = .06)), respectively. Also, topical nitroglycerin did not prevent RAS (RR: 0.73 with 95% CI [0.42–1.24], p = .24). Compared with placebo, subcutaneous nitroglycerin during transradial catheterization reduced the incidence of RAS and RAO. Meanwhile, Intra‐arterial and topical nitroglycerin did not show statistically significant outcomes. Subcutaneous nitroglycerin may be a practical and cost‐effective technique to facilitate transradial catheterization; however, more RCTs are needed to evaluate the subcutaneous versus intra‐arterial nitroglycerin administration.

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The efficacy of nitroglycerin to prevent radial artery spasm and occlusion during and after transradial catheterization: A systematic review and meta‐analysis of randomized controlled trials

Cited by 10 publications

References 50 publications

Radial artery spasms – angiographic morphology, risk factors and management

Radial artery spasms – angiographic morphology, risk factors and management

Incidence and Prognostic Factors of Radial Artery Occlusion in Transradial Coronary Catheterization

The efficacy of nitroglycerin to prevent radial artery spasm and occlusion during and after transradial catheterization: A systematic review and meta‐analysis of randomized controlled trials

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