Radial artery spasm during transradial coronary procedures

Although transradial access (TRA) for coronary procedures has many advantages over the transfemoral approach, it's still not the dominant route used in coronary interventions. Radial artery spasm (RAS) is an important limitation of TRA. We performed a search of published literature to estimate the prevalence and possible risk factors of RAS in patients undergoing transradial coronary procedure. Nineteen published papers including 7197 patients were identified as relevant; reported incidence of RAS was 14.7% altogether. It varies depending upon the criteria used, on applied premedications, and on sheath or catheter selection. Use of hydrophilic coated sheaths and catheters can reduce the incidence of RAS to 1%, while intra-arterial application of verapamil (1.25-5 mg) and nitroglycerin (100-200 μg) can reduce the incidence of RAS up to 3.8%. We concluded that RAS is still problematic in transradial access, and that besides hydrophilic materials, the use of intra-arterial vasodilators remains mandatory in RAS prevention. However, the optimal spasmolytic cocktail is yet to be confirmed by valid spasm criteria.