Changes in radial artery volume assessed using intravascular ultrasound: a comparison of two vasodilator regimens in transradial coronary interventions.
ABSTRACT This study used intravascular ultrasound (IVUS) to evaluate radial artery volume changes after intraarterial administration of nitroglycerin and/or verapamil.
Radial artery spasm, which is associated with radial artery size, is the main limitation of the transradial approach in percutaneous coronary interventions (PCI).
This prospective, randomized study compared the effect of two intra-arterial vasodilator regimens on radial artery volume: 0.2 mg of nitroglycerin plus 2.5 mg of verapamil (Group 1; n = 15) versus 2.5 mg of verapamil alone (Group 2; n = 15). Radial artery lumen volume was assessed using IVUS at two time points: at baseline (5 minutes after sheath insertion) and post-vasodilator (1 minute after drug administration). The luminal volume of the radial artery was computed using ECOC Random Fields (ECOC-RF), a technique used for automatic segmentation of luminal borders in longitudinal cut images from IVUS sequences.
There was a significant increase in arterial lumen volume in both groups, with an increase from 451 ± 177 mm³ to 508 ± 192 mm³ (p = 0.001) in Group 1 and from 456 ± 188 mm³ to 509 ± 170 mm³ (p = 0.001) in Group 2. There were no significant differences between the groups in terms of absolute volume increase (58 mm³ versus 53 mm³, respectively; p = 0.65) or in relative volume increase (14% versus 20%, respectively; p = 0.69).
Administration of nitroglycerin plus verapamil or verapamil alone to the radial artery resulted in similar increases in arterial lumen volume according to ECOC-RF IVUS measurements.
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ABSTRACT: This is a "proof of concept" study to assess feasibility of transradial access without use of vasodilators. Radial artery spasm (RAS) is an important cause of patient discomfort and procedural failure with use of radial access. Vasodilators are routinely used to prevent RAS. However, the use of vasodilators may not be appropriate in substantial groups of patients. These include patients with myocardial infarction and low blood pressure who will benefit from radial access the most. No specific recommendations about use of vasodilators in these settings are stated on consensus documents on radial access. During a short period of shortage of verapamil in our country, 15 consecutive patients underwent cardiac catheterization by transradial route without the use of vasodilators. Procedural success, and pain perceived by the patients along with radial occlusion after the procedure were assessed. In 14 of the 15 patients, the procedure was completed successfully without the use of vasodilators. In one patient, RAS developed and the procedure could be completed after injection of verapamil. Mean pain score was 5.3 on a scale of 0 to 10. No radial occlusion was detected early after the procedure. In three of the patients, a reason that would otherwise preclude use of a vasodilator was identified. Radial access can safely and effectively be performed without the use of vasodilators. Consideration of this approach when use of vasodilators is not appropriate should be formally discussed by the interventional cardiology community.International Journal of Angiology 03/2014; 23(1):41-6. DOI:10.1055/s-0033-1358384
International journal of cardiology 03/2014; 173(3). DOI:10.1016/j.ijcard.2014.03.041 · 6.18 Impact Factor
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ABSTRACT: Verapamil is traditionally applied prophylactically in transradial procedures to prevent radial artery spasm. However, verapamil may have side effects and is contraindicated in some clinical settings. During an investigator-initiated, randomized, double-blind trial, we evaluated the need for preventive verapamil administration. After vascular access was established, patients received either 5 mg verapamil (n=297) or placebo (n=294). We compared the rate of access site conversions as primary end point using a superiority margin of 5%. Occurrence of code breaks (composite of conversions and unplanned use of verapamil), overall verapamil use, procedural and fluoroscopic times, contrast volume, and subjective pain were investigated as secondary end points. The rate of access site conversions was not different in the 2 arms (placebo 1.7% versus verapamil 0.7%, P=0.28, difference 1.0%, 95% CI for the difference -1.1% to 3.3%). Proportion of code breaks was similar in the 2 groups (3.4% versus 1.3%, P=0.11), whereas overall verapamil use was markedly lower in the placebo arm (2.0% versus 100%, P<0.0001). Procedural time (median [IQR] 16.0 minutes [9.0 to 30.0 minutes] versus 17.0 minutes [10.0 to 31.0 minutes], P=0.37), fluoroscopic time (4.4 minutes [2.1 to 9.6 minutes] versus 4.8 minutes [2.4 to 10.7 minutes], P=0.28), contrast volume (72.5 mL [48.0 to 146.0 mL] versus 75.5 mL [47.0 to 156.5 mL], P=0.74), and pain score (P for trend=0.12) were comparable in the 2 groups. The preventive use of verapamil may be unnecessary for transradial procedures. The omission of prophylactic verapamil may not only reduce the rate of potential complications related to the drug but also allow the safe extension of the transradial method to those with contraindications to verapamil. http://www.clinicaltrials.gov. Unique identifier: NCT01402427.Journal of the American Heart Association 03/2014; 3(2):e000588. DOI:10.1161/JAHA.113.000588 · 2.88 Impact Factor