title: Pressure-mediated versus pharmacologic treatment of radial artery spasm during cardiac catheterisation: a randomised pilot study.
abstract: OBJECTIVE
  The aim of the study was to determine the effectiveness of a novel strategy to treat radial artery spasm (RAS).
  
  
  RESULTS
  We conducted a prospective, randomised, single-centre, open-label trial comparing a novel strategy of pressure-mediated dilatation versus intra-arterial administration of a combination of nitroglycerine plus verapamil for the treatment of RAS. The primary endpoint was radial artery intraluminal diameter acute gain assessed by quantitative radial angiography. After screening two hundred and twenty consecutive cases, twenty patients presented with RAS and were randomised 1:1 to either strategy. Overall the mean age was 60.8±11.5 years and 53% were females. Pre-treatment angiographic characteristics were similar between the groups. The primary endpoint of radial artery acute gain was significantly greater in the pressure-mediated dilatation group (0.85±0.46 mm vs. 0.03±0.24 mm, p<0.001). Blood pressure drop was significantly lower in the pressure-mediated dilatation group (ΔBP -3.8±24 vs. -31.6±19 mmHg, p<0.001). There was one case of radial artery occlusion in the pressure-mediated dilatation group at follow-up. Short-duration pain was observed during the application of pressure.
  
  
  CONCLUSIONS
  Pressure-mediated dilatation for the treatment of RAS was feasible, with superior angiographic results compared to a pharmacologic vasodilator strategy, with no impact on blood pressure. This novel approach proved to be safe and effective and should be tested in a large randomised trial.
authors.affiliation: Department of Cardiology, Academic Medical Center, Amsterdam University, Amsterdam, the Netherlands.
authors.forename: Carlos
authors.initials: C
authors.lastname: Collet
authors.forename: Juan M
authors.initials: JM
authors.lastname: Corral
authors.forename: Rafael
authors.initials: R
authors.lastname: Cavalcante
authors.forename: Hiroki
authors.initials: H
authors.lastname: Tateishi
authors.forename: Oward
authors.initials: O
authors.lastname: Belzarez
authors.forename: Jose
authors.initials: J
authors.lastname: Ribamar Costa
authors.forename: Ricardo
authors.initials: R
authors.lastname: Costa
authors.forename: Daniel
authors.initials: D
authors.lastname: Chamié
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Onuma
authors.forename: Robbert J
authors.initials: RJ
authors.lastname: de Winter
authors.forename: Alexandre
authors.initials: A
authors.lastname: Abizaid
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000008:administration & dosage; D010865:Pilot Projects; D011446:Prospective Studies; D017534:Radial Artery / Q000000981:diagnostic imaging; D013035:Spasm / Q000628:therapy*; D014654:Vascular Patency / Q000187:drug effects; D014664:Vasodilation; D014700:Verapamil / Q000008:administration & dosage
chemical_list: D014700:Verapamil; D005996:Nitroglycerin