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Introdução: O benefício do cateterismo transradial já foi confirmado em pacientes do sexo feminino. Mulheres submetidas a exames por cateterismo transradial apresentam desafios únicos. A ocorrência de espasmo e oclusão da artéria radial após o procedimento é maior em mulheres. Objetivamos avaliar o benefício da nitroglicerina na redução de espasmo e oclusão da artéria radial em mulheres submetidas a cateterismo transradial. Métodos: Estudo multicêntrico, prospectivo, randomizado 2x2 fatorial, duplo-cego. Participantes foram randomizados para nitroglicerina 500mcg ou placebo em dois momentos: após colocação do introdutor hemostático e antes da retirada. A avaliação de espasmo da artéria radial foi clínica, por meio de escala dor. A avaliação da oclusão da artéria radial foi realizada com Doppler, nas primeiras 12 horas. Resultados: Foram incluídos 2.040 pacientes, sendo 774 (37,5%) mulheres. A média de idade foi similar entre os sexos (62,2 anos versus 61,5 anos; p=0,27). A incidência de espasmo da artéria radial foi maior nas mulheres (21,2% versus 6,6%; p<0,01), bem como a incidência de oclusão da artéria radial (3,4% versus 1,8%; p=0,03). O uso da nitroglicerina no início do procedimento não reduziu a incidência de espasmo da artéria radial em mulheres quando comparado com o placebo (19,7% versus 22,6%; p=0,34), tampouco as taxas de oclusão da artéria radial (4,3% versus 2,5%; p=0,17). O uso da nitroglicerina ao fim do procedimento não reduziu a incidência de oclusão da artéria em mulheres (2,8% versus 3,9%; p=0,37). Conclusões: O espasmo e a oclusão da artéria radial são mais frequentes em mulheres submetidas a cateterismo transradial quando comparadas aos homens. O uso da nitroglicerina não apresenta efeito benéfico na redução dessas incidências.
Background: The benefit of transradial catheterization is well established in female patients. Women undergoing transradial catheterization exams present with unique challenges. The occurrence of radial artery spasm and occlusion after the procedure is higher in women. The objective of this study was to evaluate the benefit of nitroglycerin in reducing radial artery spasm and occlusion in women undergoing transradial catheterization. Methods: This was a 2x2 factorial randomized, multicenter, prospective, double-blinded study. Participants were randomized to nitroglycerin 500mcg or placebo at two time points: after placement of the hemostatic introducer and before its removal. The evaluation of the radial artery spasm was clinical, using a pain scale The evaluation of the radial artery occlusion was performed with Doppler, in the first 12 hours. Results: A total of 2,040 patients were included, of which 774 (37.5%) were female. Mean age was similar between sexes (62.2 years versus 61.5 years; p=0.27). The incidence of radial artery spasm was higher in women (21.2% versus 6.6%; p<0.01), as well as the incidence of radial artery occlusion (3.4% versus 1.8%; p=0.03). The use of nitroglycerin at the beginning of the procedure did not reduce the incidence of radial artery spasm in women when compared with placebo (19.7% versus 22.6%; p=0.34), nor did the rates of radial artery occlusion (4.3% versus 2.5%; p=0.17). The use of nitroglycerin at the end of the procedure did not reduce the incidence of artery occlusion in women (2.8% versus 3.9%; p=0.37). Conclusions: Radial artery spasm and occlusion are more frequent in women undergoing transradial catheterization when compared to men. The use of nitroglycerin does not have a beneficial effect in reducing these incidences.
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Objective To analyze and summarize the risk factors of radial artery spasm in patients with acute myocardial infarction treated by radial artery interventional therapy??Methods From August 2017 to August 2018,257 patients with chest pain in Deyang Second People＇s Hospital were selected and treated by percutaneous coronary intervention ( PCI) through radial artery approach??According to the presence or absence of radial artery spasm, the patients were divided into two groups??The radial artery fistula group (RAS) and the non?RAS group??All data were statistically analyzed using SPSS 19??0 software??Results The following indicators were statistically different between the RAS group and the non?RAS group: age,gender, diabetes,hypertension,hyperlipidemia,smoking history,radial artery anatomy,catheter exchange times,radial artery diameter／height, radial artery diameter／catheter diameter, anxiety, excessive operation time, intraoperative moderate to severe forearm pain, the number of stents, grade 2, 3, and 4 of radial artery pulsation??There were significant differences between two groups(all P＜0??05)??Multivariate analysis showed:gender(OR(95%CI): 0??92( 0??897－0??944),P＝0??043), hyperlipidemia ( OR ( 95%CI): 3??249 ( 2??508－4??208),P＝0??016),radial artery anatomy ( OR( 95%CI): 5??19 ( 2??090－12??886, P＝0??012), catheter exchange times( OR(95%CI): 6??19(3??087－12??413,P＝0??011),radial artery diameter／height( OR(95%CI): 3??56 ( 1??527－8??302, P＝0??035), radial artery diameter／catheter diameter ( OR ( 95%CI): 2??968 (1??665－5??291),P＝0??029),intraoperative moderate to severe forearm pain( OR(95%CI): 3??543(1??394－9??006), P ＝ 0??039 ) were independent risk factors for the induction of radial artery spasm in the interventional treatment of the radial artery??The difference between the two groups was statistically significant??ROC curve analysis showed that the area under the curve of the number of catheter exchanges, radial artery diameter／height, radial artery diameter／catheter diameter and the combined diagnosis were 0??806,0??674,0??645,and 0??895,respectively??By comparison,AUC of the combined diagnosis were highest, followed by catheter exchange times, radial artery diameter／height and radial artery diameter／catheter diameter were relatively lower??The best diagnostic point of catheter exchange times was 11??585, with a sensitivity of 0??86 and a specificity of 0??58??The best diagnostic point of radial artery diameter／height was 11??145,with a sensitivity of 71??8% and a specificity of 0??56??The best diagnostic point of arterial diameter／catheter diameter was 9??31,with a sensitivity of 95??3 and a specificity of 32??0%??The best diagnostic point of the combined diagnosis was 9??63, with a sensitivity of 0??72 and a specificity of 0??88??Conclusion Independent risk factors for radial artery spasm in the interventional treatment of the radial artery include catheter exchange times, radial artery anatomy, radial artery diameter／height, intraoperative moderate and severe forearm pain,hyperlipidemia,age and gender,and female incidence is greater than male??
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Objective This study aimed to study the effect of intra-brachial nitroglycerin administration via the angiography catheter on radial artery spasm in transradial percutaneous coronary intervention. Methods From patients undergoing transradial percutaneous coronary intervention (TRI) and succeeding in coronary angiography (CAG), 810 patients who needed percutaneous coronary intervention (PCI) (including Percutaneous Transluminal Coronary Angioplasty and/or stent implantation) were erolled, including 413 patients in the study group and 397 patients in the control group. When coronary angiography completed, positioned the angiography catheter over brachial artery and patients in the group received an administration of 400μg nitroglycerin via the angiography catheter. The control group received an administration of 400μg nitroglycerin via the sheath. The incidence of RAS were recored and compared. Resultes Baseline characteristics were similar between two groups. In the study group, the incidence of RAS was signiifcatively lower (18 vs. 33, P=0.021). Conclusions Intra-brachial nitroglycerin administration via the angiography catheter can prevent RAS during the insertion of guiding catheter in TRI.
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Objective To compare the effect of different dosage of verapamil and a cocktail therapy(verapamil 200 ?g plus nitroglycerin 200 ?g) in the prevention of radial artery spasm(RAS) during transradial PCI.Methods It is a prospective,randomized and double-blind clinical trial.Patients who received transradial coronary intervention were divided into three groups: group A(verapamil 200 ?g),group B(verapamil 1mg) and group C(verapamil 200 ?g plus nitroglycerin 200 ?g).Different drug protocols were given randomly to the patients after sheath insertion.The diagnostic criteria is clinical definition of RAS documented by angiography.The incidence of RAS and adverse effects in each group was compared.Results A total of 621 patients were enrolled,and there were 205 in group A,207 in group B and 210 in group C.The baseline characteristics were of no difference among the three groups.Univariate analysis showed that the incidence of RAS in group A is higher than that in group B(17.1% vs.10.2%,P=0.045) and in group C(17.1% vs.9.5%,P=0.029),but there was no statistical difference in the RAS incidence between group B and C(10.2% vs.9.5%,P=0.870).Binary logistic regression analysis showed that the relative risk of RAS in group B decreased by 32.1% compared with group A(P=0.038),and the relative risk in group C decreased by 43.8% compared with group A(P=0.017).The incidences of adverse effect were similar in groups A and C,but was higher in group B when compared with group A(9.7% vs.2.4%,P=0.003) and C(9.7% vs.3.8%,P=0.019),respectively.Conclusion Verapamil 200 ?g plus nitroglycerin 200 ?g is recommended to prevent RAS during transradial coronary intervention in Chinese.