Prevention of arterial spasm during percutaneous coronary interventions through radial artery: the SPASM study.
OBJECTIVE
Radial artery spasm remains the major limitation of transradial approach for percutaneous coronary interventions. The aim of our study was to evaluate the efficacy of vasodilators in the prevention of radial artery spasm during percutaneous coronary interventions.


RESULTS
1,219 patients were consecutively randomized to receive placebo (n = 198), molsidomine 1 mg (n = 203), verapamil 2.5 mg (n = 409), 5 mg (n = 203) or verapamil 2.5 mg and molsidomine 1 mg (n = 206). All drugs were administered through the arterial sheath. The primary end point was the occurrence of a radial artery spasm defined by the operator as severe limitation of the catheter movement, with or without angiographic confirmation. Main characteristics including age, sex, wrist and arterial sheath diameters and procedure duration were identical across the groups. The rate of radial artery spasm was lowest in patients receiving verapamil and molsidomine (4.9%), compared to verapamil 2.5 mg or 5 mg (8.3 and 7.9%), or molsidomine 1 mg (13.3%); and placebo (22.2%) (P < 0.0001).


CONCLUSIONS
Radial artery spasm during transradial percutaneous interventions was effectively prevented by the administration of vasodilators. The combination of verapamil 2.5 mg and molsidomine 1 mg provided the strongest relative risk reduction of spasm compared to placebo and should therefore be recommended during percutaneous coronary interventions through the radial approach.
Varenne
Olivier
O
Cardiology Department, Cochin Hospital, Paris 5 School of Medicine, Rene Descartes Univeristy, Paris, France. olivier.varenne@cch.aphp.fr
Jégou
Arnaud
A
Cohen
Remy
R
Empana
Jean Philippe
JP
Salengro
Emmanuel
E
Ohanessian
Alice
A
Gaultier
Cédric
C
Allouch
Philippe
P
Walspurger
Sylvie
S
Margot
Olivier
O
El Hallack
Abdel
A
Jouven
Xavier
X
Weber
Simon
S
Spaulding
Christian
C
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D003329:Coronary Vasospasm / Q000209:etiology / Q000517:prevention & control*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008981:Molsidomine / Q000627:therapeutic use*; D017534:Radial Artery; D014665:Vasodilator Agents / Q000627:therapeutic use*; D014700:Verapamil / Q000627:therapeutic use*
D014665:Vasodilator Agents; D014700:Verapamil; D008981:Molsidomine