The Role of Oral Verapamil in Preventing Radial Spasm During Transradial Angiography

Radial artery spasm (RAS) is the most common complication of transradial cardiac catheterization (TRA), potentially leading to procedural failure, crossover to an alternative access site, and increased patient discomfort. Preventing RAS is critical for procedural success and safety.

To evaluate whether pre-procedural administration of oral verapamil reduces the incidence of clinical and ultrasound-defined radial artery spasm in patients undergoing TRA.

We conducted a prospective, randomized clinical trial (NCT06447688) comparing 120 mg of oral verapamil with placebo administered 2 h before the procedure. The primary endpoints were the incidence of clinical RAS and ultrasound-based radial artery area change. Secondary endpoints included procedural success, contrast volume, dose area product, and fluoroscopy time.

Among 231 screened patients, 150 were randomized (75 verapamil, 75 placebo). The verapamil group showed significantly lower rates of clinical RAS (4% vs. 30.7%, p < 0.001) and ultrasonographically defined RAS (10.7% vs. 48%, p < 0.001). In addition, reductions in proximal and middle radial artery area were significantly smaller in the verapamil group (p < 0.001 for both). No significant differences were observed in procedural success, fluoroscopy time, radiation dose, or contrast volume.

Oral verapamil administered 2 h before TRA significantly reduces the rate of radial artery spasm and vasoconstriction. This strategy may improve patient comfort and procedural outcomes without increasing adverse effects.