title: Effectiveness of sublingual nitroglycerin before puncture compared with conventional intra-carterial nitroglycerin in transradial procedures: a randomized trial.
abstract: OBJECTIVE
  Sublingual (SL) nitroglycerin administered before radial artery puncture can improve cannulation success and decrease the incidence of radial artery spasm (RAS) compared with intra-arterial (IA) nitroglycerin in transradial procedures.
  
  
  METHODS
  Patients undergoing diagnostic transradial angiography were randomized to IA (200 mcg) or SL (400 mcg) nitroglycerin. Primary endpoints were puncture time and puncture attempts. Secondary endpoint was the incidence of RAS.
  
  
  RESULTS
  Total of 101 participants (mean age 60±11years, 53% male) were randomized (51 in IA and 50 in SL groups). Puncture time (50 [36-75] vs 50 [35-90] sec), puncture attempts (1.18±0.48 vs 1.20±0.49), multiple punctures (13.7 vs 16.0%) and RAS (19.6 vs 24.0%) were not statistically different between IA vs SL groups respectively. A composite endpoint of all adverse events related to transradial angiography (multiple punctures, RAS, access site crossover, hypotension/bradycardia associated with nitroglycerin and radial artery occlusion) was very similar in IA vs SL groups (39 vs 40%, respectively). However puncture time was significantly longer with SL nitroglycerin in patients <1.65m height (47 [36-66] vs 63 [41-110] sec, p=0.042). Multiple punctures seemed higher with SL nitroglycerin in patients with diabetes (0 vs 30%, p=0.028) or in patients <1.65m height (7.4 vs 25%, p=0.085). Likewise, RAS with SL nitroglycerin seemed more frequent in smokers compared to IA nitroglycerin (0 vs 27%, p=0.089).
  
  
  CONCLUSIONS
  SL nitroglycerin was not different from IA nitroglycerin in terms of efficiency and safety in overall study population. However it may be inferior to IA nitroglycerin in certain subgroups (shorter individuals, diabetics and smokers).
authors.affiliation: Cardiology Department, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey. Electronic address: drburakturan@gmail.com.
authors.forename: Burak
authors.initials: B
authors.lastname: Turan
authors.affiliation: Cardiology Department, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey.
authors.forename: Tolga
authors.initials: T
authors.lastname: Daşlı
authors.affiliation: Cardiology Department, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey.
authors.forename: Ayhan
authors.initials: A
authors.lastname: Erkol
authors.affiliation: Cardiology Department, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey.
authors.forename: İsmail
authors.initials: İ
authors.lastname: Erden
mesh_terms: D000286:Administration, Sublingual; D000368:Aged; D001157:Arterial Occlusive Diseases / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods*; D017023:Coronary Angiography / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000008:administration & dosage*; D011446:Prospective Studies; D011677:Punctures; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey; D014661:Vasoconstriction / Q000187:drug effects; D014665:Vasodilator Agents / Q000008:administration & dosage*
chemical_list: D014665:Vasodilator Agents; D005996:Nitroglycerin
keywords: Angiography; Nitroglycerin; Radial artery