Evaluation of Pulse Wave Analysis for Detecting Arterial Tone Changes During Transradial Access Coronary Angiography

According to guideline recommendations, transradial access coronary angiography and percutaneous coronary intervention are the current gold standards. Although it reduces overall mortality and major bleeding, a significant proportion of patients develop radial artery spasms. In this trial, we aimed to investigate potential risk constellations during the whole procedure of coronary angiography by repetitive pulse wave analysis (PWA) measurements.

In this prospective pilot study, we included 36 patients with a guideline-based indication for coronary angiography. Repetitive PWA measurements were performed at the following time points: baseline, after sheath insertion, after administration of nitroglycerin, after guidewire crossing, and at the end of the procedure. We aimed to identify critical procedural steps that alter vascular tone and predispose to vasospasm.

Radial spasm occurred in 8% (n=3), and access site conversion to transfemoral was necessary in 3% of all cases (n=1). We could not detect significant changes in pulse wave parameters throughout the procedure. We observed a non-significant drop in systolic blood pressure after sheath insertion by about 7 mmHg and a non-significant slight decrease in diastolic blood pressure after guidewire crossing by 3 to 5 mmHg.

PWA measurements during coronary angiography are feasible and easy to use. However, we could not detect significant changes in individual PWA parameters throughout the procedure. The assessment of vascular tone by PWA during coronary angiography is very challenging. Large-scale trials are needed to gain further clarity and detect potential subtle effects.