title: Evaluation of a spasmolytic cocktail to prevent radial artery spasm during coronary procedures.
abstract: Radial artery spasm is a frequent complication of the transradial approach for coronary angiography and angioplasty. Recently, we have been able to quantify spasm using the automatic pullback device. The objective of this study was to assess the efficacy of an intra-arterial vasodilating cocktail in reducing the incidence and severity of radial artery spasm. A hundred patients undergoing coronary procedures via the radial artery were divided into two groups of 50 each. Patients in group A received intra-arterial cocktail (5 mg of verapamil plus 200 micro g nitroglycerine in 10 ml of normal saline), while patients in group B did not receive any vasodilating drug. The pullback device was used for sheath removal at the end of the procedure. Seven (14%) patients in group A experienced pain (i.e., pain score of III-V) during automatic sheath removal, as compared to 17 (34%) in group B (P = 0.019). The mean pain score was significantly lower in group A than in group B (1.7 +/- 0.94 vs. 2.08 +/- 1.07; P = 0.03). The maximal pullback force (MPF) was also significantly lower for group A (0.53 +/- 0.52 kg; range, 0.10-3.03 kg) as compared to group B (0.76 +/- 0.45 kg; range, 0.24-1.99 kg; P = 0.013). Only 4 (8%) patients in group A had an MPF value greater than 1.0 kg, suggesting the presence of significant radial artery spasm, as opposed to 11 (22%) in group B (P = 0.029). Administration of an intra-arterial vasodilating cocktail prior to sheath insertion reduces the occurrence and severity of radial artery spasm.
authors.affiliation: Amsterdam Department of Interventional Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands. ferdi@euronet.nl
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Kiemeneij
authors.forename: Bhavesh U
authors.initials: BU
authors.lastname: Vajifdar
authors.forename: Simon C
authors.initials: SC
authors.lastname: Eccleshall
authors.forename: GertJan
authors.initials: G
authors.lastname: Laarman
authors.forename: Ton
authors.initials: T
authors.lastname: Slagboom
authors.forename: Ron
authors.initials: R
authors.lastname: van der Wieken
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D017130:Angioplasty / Q000009:adverse effects* / Q000295:instrumentation*; D017023:Coronary Angiography / Q000009:adverse effects* / Q000295:instrumentation*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000008:administration & dosage / Q000627:therapeutic use*; D010146:Pain / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D010147:Pain Measurement; D010276:Parasympatholytics / Q000008:administration & dosage / Q000627:therapeutic use*; D017534:Radial Artery / Q000187:drug effects* / Q000503:physiopathology; D012720:Severity of Illness Index; D013035:Spasm / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control*; D013718:Tensile Strength / Q000187:drug effects / Q000502:physiology; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D014700:Verapamil / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D010276:Parasympatholytics; D014665:Vasodilator Agents; D014700:Verapamil; D005996:Nitroglycerin