Key result
Intra-arterial verapamil and nitroglycerine cocktail reduces sheath removal pain by ~59% versus no vasodilator.
Why the study?
Does an intra-arterial vasodilating cocktail reduce the incidence and severity of radial artery spasm in patients undergoing coronary procedures via the radial artery?
RCT (n=100)
Does an intra-arterial vasodilating cocktail reduce the incidence and severity of radial artery spasm in patients undergoing coronary procedures via the radial artery?
Administration of an intra-arterial cocktail of verapamil and nitroglycerine prior to sheath insertion significantly reduces the occurrence and severity of radial artery spasm during transradial coronary procedures.
Answers are grounded in this paper and cite their sources.
May reduce sheath removal pain in transradial access; leaves open whether vasodilator cocktails prevent radial spasm in randomized trials.
Radial artery spasm is a frequent complication of the transradial approach for coronary angiography and angioplasty. Recently, we have been able to quantify spasm using the automatic pullback device. The objective of this study was to assess the efficacy of an intra-arterial vasodilating cocktail in reducing the incidence and severity of radial artery spasm. A hundred patients undergoing coronary procedures via the radial artery were divided into two groups of 50 each. Patients in group A received intra-arterial cocktail (5 mg of verapamil plus 200 micro g nitroglycerine in 10 ml of normal saline), while patients in group B did not receive any vasodilating drug. The pullback device was used for sheath removal at the end of the procedure. Seven (14%) patients in group A experienced pain (i.e., pain score of III-V) during automatic sheath removal, as compared to 17 (34%) in group B (P = 0.019). The mean pain score was significantly lower in group A than in group B (1.7 +/- 0.94 vs. 2.08 +/- 1.07; P = 0.03). The maximal pullback force (MPF) was also significantly lower for group A (0.53 +/- 0.52 kg; range, 0.10-3.03 kg) as compared to group B (0.76 +/- 0.45 kg; range, 0.24-1.99 kg; P = 0.013). Only 4 (8%) patients in group A had an MPF value greater than 1.0 kg, suggesting the presence of significant radial artery spasm, as opposed to 11 (22%) in group B (P = 0.029). Administration of an intra-arterial vasodilating cocktail prior to sheath insertion reduces the occurrence and severity of radial artery spasm.
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Kiemeneij et al. (2003) conducted an RCT in Radial artery spasm during coronary procedures (n=100). Intra-arterial vasodilating cocktail (verapamil and nitroglycerine) vs. No vasodilating drug was evaluated on Pain (pain score of III-V) during automatic sheath removal (p=0.019). An intra-arterial vasodilating cocktail of verapamil and nitroglycerine significantly reduced the incidence of pain during sheath removal compared to no vasodilating drug (14% vs 34%; P=0.019).
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