title: A novel approach to reduce radial artery occlusion after transradial catheterization: postprocedural/prehemostasis intra-arterial nitroglycerin.
abstract: OBJECTIVE
  To evaluate whether administration of nitroglycerin through the sheath at the end of a transradial procedure might preserve the patency of the radial artery.
  
  
  BACKGROUND
  Despite the increasing acceptance of transradial approach, radial artery occlusion (RAO) continues to be a vexing problem of transradial access and limits utility of the radial artery as an access site in the future.
  
  
  METHODS
  We conducted a multicenter, prospective, randomized, placebo-controlled, operator-blinded trial and enrolled 1,706 patients who underwent transradial catheterization in three experienced radial centers. Patients were randomized to receive either 500 µg nitroglycerin (n=853) or placebo (n=853), given intra-arterially through the sheath at the end of the radial procedure. The primary outcome was the incidence of RAO as confirmed by absence of antegrade flow at one day after the transradial procedure evaluated by duplex ultrasound of the radial artery.
  
  
  RESULTS
  The use of nitroglycerin, as compared with placebo, reduced the risk of the primary outcome [8.3% vs. 11.7%; odds ratio, 0.62; 95% confidence interval (CI), 0.44-0.87; P=0.006]. From a multivariable analysis, duration of hemostasis was a predictor of RAO (odds ratio, (odds ratio, 3.11; 95% CI, 1.66 to 5.82; P<0.001). There were no significant differences between the groups with respect to the sheath size (P=0.311), number of puncture attempts (P=0.941), duration of hemostasis (P=0.379) and procedural time (P=0.095).
  
  
  CONCLUSIONS
  The administration of nitroglycerin at the end of a transradial catheterization, reduced the incidence of RAO, examined 1 day after the radial procedure by ultrasound. Postprocedural/prehemostasis pharmacologic regimens may represent a novel target for further investigation to reduce RAO.
authors.affiliation: Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita Jakarta, Indonesia.
authors.forename: Surya
authors.initials: S
authors.lastname: Dharma
authors.forename: Sasko
authors.initials: S
authors.lastname: Kedev
authors.forename: Tejas
authors.initials: T
authors.lastname: Patel
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Kiemeneij
authors.forename: Ian C
authors.initials: IC
authors.lastname: Gilchrist
mesh_terms: D000792:Angiography; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000008:administration & dosage*; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D011446:Prospective Studies; D017534:Radial Artery; D018843:Republic of North Macedonia / Q000453:epidemiology; D016037:Single-Blind Method; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D014665:Vasodilator Agents; D005996:Nitroglycerin
keywords: nitroglycerin; radial artery occlusion; transradial approach