Randomized Clinical Trial on Prevention of Radial Occlusion After Transradial Access Using Nitroglycerin

Silva, Roberto Léo da; Andrade, Pedro Beraldo de; Dangas, George; Joaquim, Rodrigo M; Silva, Thais R W da; Vieira, Ramiro; Pereira, Vanderlei C; Sousa, Amanda G.M.R.; Feres, Fausto; Costa, José R

doi:10.1016/j.jcin.2022.02.026

Cited by 9 publications

(28 citation statements)

References 25 publications

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“…One of them was DRA, which has been proposed as a potential approach to prevent RAO because of its anatomical basis and physiological rationale [ 25 ]. This fact becomes even more relevant after the publication of two recent studies that showed RAO is not affected by the low dose of rivaroxaban (10 mg) administered shortly after the procedure or by the systematic administration of nitroglycerin at the beginning and end of the procedure [ 26 , 27 ]. Of note, in an experimental study in healthy volunteers, simulated occlusion of the distal radial artery in the anatomic snuffbox did not cause significant flow reduction in the forearm radial artery compared with simulated occlusion of the radial artery at the wrist [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Distal Radial Artery Access for Recanalization of Radial Artery Occlusion and Repeat Intervention: A Single Center Experience

Achim

Kákonyi

Jambrik

et al. 2022

JCM

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Background: Once occluded, the radial artery becomes unsuitable for repeat interventions and obligates the need for alternative vascular access, such as the femoral approach, which is not encouraged by current guidelines. With the dissemination of distal radial access (DRA), which allows the cannulation of the artery in its distal segment and which remains patent even in the case of radial artery occlusion (RAO), the option to perform angioplasty at this level becomes feasible. Methods: Thirty patients with RAO were enrolled in this pilot study. Recanalization was performed through DRA using hydrophilic guidewires. The feasibility endpoint was procedural success, namely the successful RAO recanalization, the efficacy endpoint was patency of the artery at 30 days, and the safety endpoint was the absence of periprocedural vascular major complications or major adverse cardiac and cerebrovascular events. Results: The mean age of the patients was 63 ± 11 years, and 15 patients (50%) were men. Most patients had asymptomatic RAO (n = 28, 93.3%), and only two (6.6%) reported numbness in their hands. The most common indication for the procedure was PCI (19, 63.2%). Total procedural time was 41 ± 22 min, while the amount of contrast used was 140 ± 28 mL. Procedural success was 100% (n = 30). Moreover, there were no major vascular complications (0%); only two small hematomas were described (10%) and one had an angiographically visible perforation (3%). One case of periprocedural stroke was reported (3%), with onset immediately after the procedure and recovering 24 h later. Twenty-seven radial arteries (90%) remained patent at the one-month follow-up. Conclusions: RAO recanalization is feasible and safe, and by using dedicated hydrophilic guidewires, the success rate is high without significantly increasing procedural time or the amount of used contrast.

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Section: Discussionmentioning

confidence: 99%

Distal Radial Artery Access for Recanalization of Radial Artery Occlusion and Repeat Intervention: A Single Center Experience

Achim

Kákonyi

Jambrik

et al. 2022

JCM

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“…RAS incidence was reported in eight studies, 8,13,17,[20][21][22][23]25 while RAO incidence was reported in four studies. 13,23,24,26 Furthermore, the safety was estimated by documenting the post manifestations of nitroglycerin administration, including hematoma, hypotension, and headache. of the risk of bias in Figure S2.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…To clarify, Kiani et al 22 reported that cannulation failed in three patients. Both Chen et al 24 and Da Silva et al 13 excluded six and 26 patients, respectively due to the radial artery being inaccessible.…”

Section: Strengthsmentioning

confidence: 99%

“…14 RAO can be identified by a visible obstruction on the two-dimensional ultrasound or by the absence of a Doppler flow signal distal to the puncture site. 13 To reduce the RAO incidence, various strategies have been utilized, including using a small-caliber catheter, anticoagulation with heparin, maintenance of patency during hemostasis, and short-term compressive dressing. 15 Vasodilators like nitroglycerin and verapamil have also been used to reduce RAO risk.…”

Section: Introductionmentioning

confidence: 99%

“…16 Facilitation of radial artery access via radial artery dilatation with the use of topical, sublingual, and subcutaneous nitroglycerin also reduces the risk of RAS by minimizing the number of puncture attempts. [17][18][19] Previous randomized controlled trials (RCTs) have evaluated the different routes of nitroglycerin administration: topical, 20,21 subcutaneous, 17,[22][23][24][25] and intra-arterial 8,13,26,27 to prevent RAS and RAO. This systemic review and meta-analysis aims to evaluate the efficacy of nitroglycerin in preventing RAS and RAO during transradial catheterization and to discuss the different routes of nitroglycerin administration.…”

Section: Introductionmentioning

confidence: 99%

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The efficacy of nitroglycerin to prevent radial artery spasm and occlusion during and after transradial catheterization: A systematic review and meta‐analysis of randomized controlled trials

Abdelazeem

Abuelazm

Swed

et al. 2022

Clinical Cardiology

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Radial artery spasm (RAS) is the most common cause of transradial access site crossover and is a common intra‐procedural complication. RAS incidence can lead to radial artery occlusion (RAO) postprocedure, preventing the radial artery as a future access site. We evaluated the efficacy of nitroglycerin preventing RAS and RAO during transradial catheterization discussing the different routes of administration, including topical, subcutaneous, and intra‐arterial. A systematic review and meta‐analysis included all relevant articles until April 23, 2022. We searched six databases Google Scholar, Web of Science, SCOPUS, EMBASE, PubMed (MEDLINE), and CENTRAL. We registered our review protocol in PROSPERO with ID: CRD42022330356. We included 11 trials with 5814 patients. Compared to placebo, the pooled analysis favored subcutaneous nitroglycerin in preventing RAS (risk ratio [RR]: 0.57 with 95% confidence interval [CI] [0.43–0.77], p = .0003) and RAO (RR: 0.39 with 95% CI [0.16–0.98], p = .05). In contrast to the intra‐arterial nitroglycerin that showed nonstatistically significant results in preventing RAS and RAO (RR: 0.8 with 95% CI [0.63–1.02], p = .07)‐ (RR: 0.78 with 95% CI [0.6–1.01], p = .06)), respectively. Also, topical nitroglycerin did not prevent RAS (RR: 0.73 with 95% CI [0.42–1.24], p = .24). Compared with placebo, subcutaneous nitroglycerin during transradial catheterization reduced the incidence of RAS and RAO. Meanwhile, Intra‐arterial and topical nitroglycerin did not show statistically significant outcomes. Subcutaneous nitroglycerin may be a practical and cost‐effective technique to facilitate transradial catheterization; however, more RCTs are needed to evaluate the subcutaneous versus intra‐arterial nitroglycerin administration.

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Effect of randomized prophylactic nitroglycerin on radial artery spasm during transradial catheterization: An analysis based on operator experience

Silva

Dangas

Andrade³

et al. 2023

Cathet Cardio Intervent

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One limitation to transradial access (TRA) is the occurrence of spasms (RAS), for which the use of prophylactic medications is recommended. Improvement in TRA material combined with the increase in operators' expertise, might mitigate this benefit. We assess the effect of preventive nitroglycerin on RAS during TRA, evaluating the role of the operator's experience. Patients received 500 μg nitroglycerin or placebo. The operator's expertise was classified as: inexperienced (I), intermediate (M), and experienced (E). 2040 patients were included. Prophylactic use of nitroglycerin did not reduce RAS (10.8% vs. 13.4% (placebo), p = 0.07). RAS incidence was 14.5% in I, 12.5% in M, and 9.7% in E (p = 0.01). In group I, nitroglycerin reduced RAS (17.4% vs. 11.1%, p = 0.04), which was not observed in other groups. Overall, nitroglycerin does not prevent RAS, which is more common among inexperienced operators. More experienced operators could abolish preventive nitroglycerin use.

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Randomized Clinical Trial on Prevention of Radial Occlusion After Transradial Access Using Nitroglycerin

Cited by 9 publications

References 25 publications

Distal Radial Artery Access for Recanalization of Radial Artery Occlusion and Repeat Intervention: A Single Center Experience

Distal Radial Artery Access for Recanalization of Radial Artery Occlusion and Repeat Intervention: A Single Center Experience

The efficacy of nitroglycerin to prevent radial artery spasm and occlusion during and after transradial catheterization: A systematic review and meta‐analysis of randomized controlled trials

Effect of randomized prophylactic nitroglycerin on radial artery spasm during transradial catheterization: An analysis based on operator experience

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