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How to limit radial artery spasm during percutaneous coronary interventions: The spasmolytic agents to avoid spasm
Julien Rosencher1, Aurès Chaïb, Franck Barbou
1AP-HP, Hôpital Cochin, Service de Cardiologie, Paris, France; Université Paris Descartes. Faculté de Médecine Paris Descartes, Paris, France.
Insights
Verapamil and isosorbide dinitrate (ISDN) are more effective than diltiazem in preventing radial artery spasm (RAS) during transradial percutaneous coronary interventions (PCI). These findings offer valuable insights for optimizing patient care during these procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Transradial percutaneous coronary interventions (PCI) are increasingly common.
- Radial artery spasm (RAS) is a frequent complication, potentially hindering the procedure.
- Effective prevention of RAS is crucial for successful PCI outcomes.
Purpose of the Study:
- To compare the efficacy of three vasodilators in preventing radial artery spasm (RAS).
- To evaluate diltiazem, verapamil, and isosorbide dinitrate (ISDN) for RAS prevention during transradial PCI.
Main Methods:
- A randomized trial involving 731 patients undergoing transradial PCI.
- Patients received either diltiazem 5 mg, verapamil 2.5 mg, or ISDN 1 mg.
- Incidence and severity of RAS, pain, and safety events were assessed.
Main Results:
- RAS occurred in 20.1% of patients.
- Verapamil and ISDN significantly reduced RAS incidence compared to diltiazem (16.2% and 17.2% vs. 26.6%, P < 0.006).
- Independent predictors of RAS included female gender, failed radial access, emergency procedures, and diltiazem use.
Conclusions:
- Verapamil and ISDN are superior to diltiazem in reducing RAS during transradial PCI.
- These findings support the use of verapamil or ISDN for RAS prevention in this patient population.
Aims:
To compare the efficacy of three vasodilators in preventing radial artery spasm (RAS) in patients undergoing transradial percutaneous coronary interventions (PCI).
Methods And Results:
731 patients were randomized to receive diltiazem 5 mg, verapamil 2.5 mg, or isosorbide dinitrate (ISDN) 1 mg before coronary intervention. RAS occurred in 20.1% in the whole population and was significantly reduced by verapamil and ISDN compared to diltiazem (16.2, 17.2, and 26.6%, respectively; P < 0.006). There was also a trend towards less severe pain (more than 8 on a numerical scale from 0 [no pain] to 10 [maximal pain]), and less severe RAS (complete catheter blockage or severe pain), among patients treated by verapamil compared to ISDN and diltiazem (1.3% vs. 2.8% vs. 2.9%, P = 0.43 and 5.1% vs. 6.2% vs. 9.5%, respectively, P = 0.13). No difference was found between the three vasodilators in terms of crossover or safety events. Female gender, failure at first attempt to access the radial artery, emergency procedures, and the use of diltiazem were independent predictors of RAS.
Conclusion:
Verapamil and ISDN considerably reduce the incidence of RAS compared to diltiazem during transradial PCI.
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