Flow-mediated dilatation to relieve puncture-induced radial artery spasm: A pilot study
Abstract
Background: Puncture-induced radial artery spasm (RAS) may extend the duration of coronary angiography (CAG) or cause transradial access failure. Flow-mediated dilatation (FMD), a widely-used noninvasive approach for assessing endothelial function, was reported to remove the entrapped radial sheath after percutaneous coronary intervention. Herein, the efficacy and safety of FMD in treating puncture-induced RAS before transradial CAG was investigated.
Methods: Ninety patients with puncture-induced RAS were randomized in a 1:1:1 ratio into three groups: FMD group was immediately treated with blockage of brachial artery blood for 5 min using a sphygmomanometric cuff and then rapid relief; nitroglycerin (NTG) group was administered with 0.5 mg sublingual NTG instantly; and the no-therapy group was treated with a wait-and-watch strategy. The time of radial pulse recovery, and regional and systemic complications were recorded.
Results: The rate of radial pulse recovery within 30 min in FMD group was significantly higher than that in no-therapy group (97% vs. 73%, p = 0.026). The median time to return of radial pulse in FMD group and NTG group was significantly shorter than that in no-therapy group (7 [6.5–9] min vs. 15 [12–18] min, 8 [7–9] min vs. 15 [12–18] min, respectively; both p < 0.001). Headache and decreased blood pressure were more prevalent in NTG group than those in FMD and no-therapy groups.
Conclusions: FMD is a feasible, noninvasive and nonpharmacological approach to relieve RAS and facilitate radial artery cannulation after an initial failed attempt. (Cardiol J 2018; 25, 1: 1–6)
Keywords: coronary angiographyflow-mediated dilatationtransradialradial artery spasmnitroglycerin
References
- Rao SV, Tremmel JA, Gilchrist IC, et al. Best practices for transradial angiography and intervention: a consensus statement from the society for cardiovascular angiography and intervention's transradial working group. Catheter Cardiovasc Interv. 2014; 83(2): 228–236.
- Campeau L, Campeau L. Percutaneous radial artery approach for coronary angiography. Cathet Cardiovasc Diagn. 1989; 16(1): 3–7.
- Kiemeneij F, Laarman GJ. Percutaneous transradial artery approach for coronary stent implantation. Cathet Cardiovasc Diagn. 1993; 30(2): 173–178.
- Feldman DN, Swaminathan RV, Kaltenbach LA, et al. Adoption of radial access and comparison of outcomes to femoral access in percutaneous coronary intervention: an updated report from the national cardiovascular data registry (2007-2012). Circulation. 2013; 127(23): 2295–2306.
- Ferrante G, Rao SV, Jüni P, et al. Radial versus femoral access for coronary interventions across the entire spectrum of patients with coronary artery disease: a meta-analysis of randomized trials. JACC Cardiovasc Interv. 2016; 9(14): 1419–1434.
- Mann T, Cubeddu G, Bowen J, et al. Stenting in acute coronary syndromes: a comparison of radial versus femoral access sites. J Am Coll Cardiol. 1998; 32(3): 572–576.
- Cooper CJ, El-Shiekh RA, Cohen DJ, et al. Effect of transradial access on quality of life and cost of cardiac catheterization: A randomized comparison. Am Heart J. 1999; 138(3 Pt 1): 430–436.
- Singh S, Singh M, Grewal N, et al. Transradial vs transfemoral percutaneous coronary intervention in st-segment elevation myocardial infarction: a systemic review and meta-analysis. Can J Cardiol. 2016; 32(6): 777–790.
- Abdelaal E, Brousseau-Provencher C, Montminy S, et al. Risk score, causes, and clinical impact of failure of transradial approach for percutaneous coronary interventions. JACC Cardiovasc Interv. 2013; 6(11): 1129–1137.
- Turan B, Daşlı T, Erkol A, et al. Effectiveness of sublingual nitroglycerin before puncture compared with conventional intra-carterial nitroglycerin in transradial procedures: a randomized trial. Cardiovasc Revasc Med. 2015; 16(7): 391–396.
- Pancholy SB, Coppola J, Patel T. Subcutaneous administration of nitroglycerin to facilitate radial artery cannulation. Catheter Cardiovasc Interv. 2006; 68(3): 389–391.
- Stout M. Flow-mediated dilatation: a review of techniques and applications. Echocardiography. 2009; 26(7): 832–841.
- Pyke KE, Tschakovsky ME. The relationship between shear stress and flow-mediated dilatation: implications for the assessment of endothelial function. J Physiol. 2005; 568(Pt 2): 357–369.
- Schretzenmayr A. Über kreislaufregulatorische Vorgänge an den großen Arterien bei der Muskelarbeit. Pflügers. Pflügers Archiv - European Journal of Physiology. 1933; 232(1): 743–748.
- Joannides R, Haefeli WE, Linder L, et al. Nitric oxide is responsible for flow-dependent dilatation of human peripheral conduit arteries in vivo. Circulation. 1995; 91(5): 1314–1319.
- Wilson C, Lee MD, McCarron JG. Acetylcholine released by endothelial cells facilitates flow-mediated dilatation. J Physiol. 2016; 594(24): 7267–7307.
- Ras RT, Streppel MT, Draijer R, et al. Flow-mediated dilation and cardiovascular risk prediction: a systematic review with meta-analysis. Int J Cardiol. 2013; 168(1): 344–351.
- Orlandi M, Suvan J, Petrie A, et al. Association between periodontal disease and its treatment, flow-mediated dilatation and carotid intima-media thickness: a systematic review and meta-analysis. Atherosclerosis. 2014; 236(1): 39–46.
- Pancholy SB, Karuparthi PR, Gulati R. A novel nonpharmacologic technique to remove entrapped radial sheath. Catheter Cardiovasc Interv. 2015; 85(1): E35–E38.
- Corretti MC, Anderson TJ, Benjamin EJ, et al. Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery: a report of the International Brachial Artery Reactivity Task Force. J Am Coll Cardiol. 2002; 39(2): 257–265.
- Dehghani P, Mohammad A, Bajaj R, et al. Mechanism and predictors of failed transradial approach for percutaneous coronary interventions. JACC Cardiovasc Interv. 2009; 2(11): 1057–1064.
- Jolly SS, Yusuf S, Cairns J, et al. RIVAL trial group. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet. 2011; 377(9775): 1409–1420.
- Schussler JM, Vasudevan A, von Bose LJ, et al. Comparative efficacy of transradial versus transfemoral approach for coronary angiography and percutaneous coronary intervention. Am J Cardiol. 2016; 118(4): 482–488.
- Charakida M, Masi S, Luscher TF, et al. Assessment of atherosclerosis: the role of flow-mediated dilatation. Eur Heart J. 2010; 31(23): 2854–2861.
- Collet C, Corral JM, Cavalcante R, et al. Pressure-mediated versus pharmacologic treatment of radial artery spasm during cardiac catheterisation: a randomised pilot study. EuroIntervention. 2017; 12(18): e2212–e2218.
- Ezhumalai B, Satheesh S, Jayaraman B. Effects of subcutaneously infiltrated nitroglycerin on diameter, palpability, ease-of-puncture and pre-cannulation spasm of radial artery during transradial coronary angiography. Indian Heart J. 2014; 66(6): 593–597.
