Abstract
Elective and emergent coronary interventions via transradial access (TRA) are been used increasingly as they carry a reduced risk of complications. Percutaneous coronary intervention via TRA may lead to radial artery spasms (RAS) that may result in prolonged procedure time, cross-over of access site, and other complications. This review article discusses the recent definitions, incidences, pathophysiology, predictive score calculator, efficacy, the safety of the radial cocktails, and treatment of the RAS.
Similar content being viewed by others
References
Kiemeneij F, Laarman GJ, Slagboom T, van der Wieken R (1997) Outpatient coronary stent implantation. J Am Coll Cardiol 29(2):323–327. https://doi.org/10.1016/s0735-1097(96)00486-x
Kiemeneij F, Laarman GJ, Odekerken D, Slagboom T, van der Wieken R (1997) A randomized comparison of percutaneous transluminal coronary angioplasty by the radial, brachial and femoral approaches: the access study. J Am Coll Cardiol 29(6):1269–1275. https://doi.org/10.1016/s0735-1097(97)00064-8
Mann T, Cubeddu G, Bowen J, Schneider JE, Arrowood M, Newman WN, Zellinger MJ, Rose GC (1998) Stenting in acute coronary syndromes: a comparison of radial versus femoral access sites. J Am Coll Cardiol 32(3):572–576. https://doi.org/10.1016/s0735-1097(98)00288-5
Goldberg SL, Renslo R, Sinow R, French WJ (1998) Learning curve in the use of the radial artery as vascular access in the performance of percutaneous transluminal coronary angioplasty. Catheter Cardiovasc Diagn 44(2):147–152
Hildick-Smith DJ, Lowe MD, Walsh JT, Ludman PF, Stephens NG, Schofield PM, Stone DL, Shapiro LM, Petch MC (1998) Coronary angiography from the radial artery--experience, complications and limitations. Int J Cardiol 64(3):231–239
Bazemore E, Mann JT 3rd (2005) Problems and complications of the transradial approach for coronary interventions: a review. J Invasive Cardiol 17(3):156–159
Rathore S, Stables RH, Pauriah M, Hakeem A, Mills JD, Palmer ND, Perry RA, Morris JL (2010) Impact of length and hydrophilic coating of the introducer sheath on radial artery spasm during transradial coronary intervention: a randomized study. JACC Cardiovasc Interv 3(5):475–483. https://doi.org/10.1016/j.jcin.2010.03.009
Goldsmit A, Kiemeneij F, Gilchrist IC, Kantor P, Kedev S, Kwan T, Dharma S, Valdivieso L, Wenstemberg B, Patel T (2014) Radial artery spasm associated with transradial cardiovascular procedures: results from the RAS registry. Catheter Cardiovasc Interv 83(1):E32–E36. https://doi.org/10.1002/ccd.25082
Kiemeneij F, Vajifdar BU, Eccleshall SC, Laarman G, Slagboom T, van der Wieken R (2001) Measurement of radial artery spasm using an automatic pullback device. Catheter Cardiovasc Interv 54(4):437–441
Kim SH, Kim EJ, Cheon WS, Kim MK, Park WJ, Cho GY, Choi YJ, Rhim CY (2007) Comparative study of nicorandil and a spasmolytic cocktail in preventing radial artery spasm during transradial coronary angiography. Int J Cardiol 120(3):325–330. https://doi.org/10.1016/j.ijcard.2006.10.008
Kristic I, Lukenda J (2011) Radial artery spasm during transradial coronary procedures. J Invasive Cardiol 23(12):527–531
He GW, Yang CQ (1995) Comparison among arterial grafts and coronary artery. An attempt at functional classification. J Thorac Cardiovasc Surg 109(4):707–715. https://doi.org/10.1016/s0022-5223(95)70352-7
Caussin C, Gharbi M, Durier C, Ghostine S, Pesenti-Rossi D, Rahal S, Brenot P, Barri M, Durup F, Lancelin B (2010) Reduction in spasm with a long hydrophylic transradial sheath. Catheter Cardiovasc Interv 76(5):668–672. https://doi.org/10.1002/ccd.22552
Fukuda N, Iwahara S, Harada A, Yokoyama S, Akutsu K, Takano M, Kobayashi A, Kurokawa S, Izumi T (2004) Vasospasms of the radial artery after the transradial approach for coronary angiography and angioplasty. Jpn Heart J 45(5):723–731. https://doi.org/10.1536/jhj.45.723
Rosencher J, Chaib A, Barbou F, Arnould MA, Huber A, Salengro E, Jegou A, Allouch P, Zuily S, Mihoub F, Varenne O (2014) How to limit radial artery spasm during percutaneous coronary interventions: the spasmolytic agents to avoid spasm during transradial percutaneous coronary interventions (SPASM3) study. Catheter Cardiovasc Interv 84(5):766–771. https://doi.org/10.1002/ccd.25163
Jia DA, Zhou YJ, Shi DM, Liu YY, Wang JL, Liu XL, Wang ZJ, Yang SW, Ge HL, Hu B, Yan ZX, Chen Y, Gao F (2010) Incidence and predictors of radial artery spasm during transradial coronary angiography and intervention. Chin Med J 123(7):843–847
Coppola J, Patel T, Kwan T, Sanghvi K, Srivastava S, Shah S, Staniloae C (2006) Nitroglycerin, nitroprusside, or both, in preventing radial artery spasm during transradial artery catheterization. J Invasive Cardiol 18(4):155–158
Dharma S, Shah S, Radadiya R, Vyas C, Pancholy S, Patel T (2012) Nitroglycerin plus diltiazem versus nitroglycerin alone for spasm prophylaxis with transradial approach. J Invasive Cardiol 24(3):122–125
Giannopoulos G, Raisakis K, Synetos A, Davlouros P, Hahalis G, Alexopoulos D, Tousoulis D, Lekakis J, Stefanadis C, Cleman MW, Deftereos S (2015) A predictive score of radial artery spasm in patients undergoing transradial percutaneous coronary intervention. Int J Cardiol 188:76–80. https://doi.org/10.1016/j.ijcard.2015.04.024
Deftereos S, Giannopoulos G, Raisakis K, Hahalis G, Kaoukis A, Kossyvakis C, Avramides D, Pappas L, Panagopoulou V, Pyrgakis V, Alexopoulos D, Stefanadis C, Cleman MW (2013) Moderate procedural sedation and opioid analgesia during transradial coronary interventions to prevent spasm: a prospective randomized study. JACC Cardiovasc Interv 6(3):267–273. https://doi.org/10.1016/j.jcin.2012.11.005
Chen CW, Lin CL, Lin TK, Lin CD (2006) A simple and effective regimen for prevention of radial artery spasm during coronary catheterization. Cardiology 105(1):43–47. https://doi.org/10.1159/000089246
Carrillo X, Fernandez-Nofrerias E, Ciompi F, Rodriguez-Leor O, Radeva P, Salvatella N, Pujol O, Mauri J, Bayes-Genis A (2011) Changes in radial artery volume assessed using intravascular ultrasound: a comparison of two vasodilator regimens in transradial coronary interventions. J Invasive Cardiol 23(10):401–404
Mont’Alverne Filho JR, Assad JA, Zago Ado C, da Costa RL, Pierre AG, Saleh MH, Barretto R, Braga SL, Feres F, Sousa AG, Sousa JE (2003) Comparative study of the use of diltiazem as an antispasmodic drug in coronary angiography via the transradial approach. Arq Bras Cardiol 81(1):59–63, 54-58. https://doi.org/10.1590/s0066-782x2003000900005
Boyer N, Beyer A, Gupta V, Dehghani H, Hindnavis V, Shunk K, Zimmet J, Yeghiazarians Y, Ports T, Boyle A (2013) The effects of intra-arterial vasodilators on radial artery size and spasm: implications for contemporary use of trans-radial access for coronary angiography and percutaneous coronary intervention. Cardiovasc Revasc Med 14(6):321–324. https://doi.org/10.1016/j.carrev.2013.08.009
Ho HH, Jafary FH, Ong PJ (2012) Radial artery spasm during transradial cardiac catheterization and percutaneous coronary intervention: incidence, predisposing factors, prevention, and management. Cardiovasc Revasc Med 13(3):193–195. https://doi.org/10.1016/j.carrev.2011.11.003
Osman F, Buller N, Steeds R (2008) Use of intra-arterial papaverine for severe arterial spasm during radial cardiac catheterization. J Invasive Cardiol 20(10):551–552
Bellien J, Thuillez C, Joannides R (2008) Role of endothelium-derived hyperpolarizing factor in the regulation of radial artery basal diameter and endothelium-dependent dilatation in vivo. Clin Exp Pharmacol Physiol 35(4):494–497. https://doi.org/10.1111/j.1440-1681.2008.04903.x
Ives SJ, Andtbacka RH, Noyes RD, McDaniel J, Amann M, Witman MA, Symons JD, Wray DW, Richardson RS (2011) Human skeletal muscle feed arteries studied in vitro: the effect of temperature on alpha(1)-adrenergic responsiveness. Exp Physiol 96(9):907–918. https://doi.org/10.1113/expphysiol.2011.059329
Colussi GL, Di Fabio A, Catena C, Chiuch A, Sechi LA (2011) Involvement of endothelium-dependent and -independent mechanisms in midazolam-induced vasodilation. Hypertens Res 34(8):929–934. https://doi.org/10.1038/hr.2011.62
Pullakhandam NS, Yang ZJ, Thomas S, Wasenko J (2006) Unusual complication of transradial catheterization. In: Anesth Analg, vol 103. vol 3. United States, pp 794-795. doi:https://doi.org/10.1213/01.ane.0000227156.20336.2c
Jolly SS, Yusuf S, Cairns J, Niemela K, Xavier D, Widimsky P, Budaj A, Niemela M, Valentin V, Lewis BS, Avezum A, Steg PG, Rao SV, Gao P, Afzal R, Joyner CD, Chrolavicius S, Mehta SR, Group RT (2011) Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet 377(9775):1409–1420. https://doi.org/10.1016/S0140-6736(11)60404-2
Ratib K, Mamas MA, Anderson SG, Bhatia G, Routledge H, De Belder M, Ludman PF, Fraser D, Nolan J, British Cardiovascular Intervention S, the National Institute for Cardiovascular Outcomes R (2015) Access site practice and procedural outcomes in relation to clinical presentation in 439,947 patients undergoing percutaneous coronary intervention in the United kingdom. JACC Cardiovasc Interv 8(1 Pt A):20–29. https://doi.org/10.1016/j.jcin.2014.06.026
Deftereos S, Giannopoulos G, Kossyvakis C et al (2011) Radial artery flow-mediated dilation predicts arterial spasm during transradial coronary interventions. Catheter Cardiovasc Interv 77(5):649–654. https://doi.org/10.1002/ccd.22688
Byrne J, Spence M, Haegeli L et al (2008) Magnesium sulphate during transradial cardiac catheterization: a new use for an old drug? J Invasive Cardiol 20(10):539–542
Varenne O, Jegou A, Cohen R et al (2006) Prevention of arterial spasm during percutaneous coronary interventions through radial artery: the SPASM study. Catheter Cardiovasc Interv 68(2):231–235. https://doi.org/10.1002/ccd.20812
Ruiz-Salmeron RJ, Mora R, Masotti M, Betriu A (2005) Assessment of the efficacy of phentolamine to prevent radial artery spasm during cardiac catheterization procedures: a randomized study comparing phentolamine vs. verapamil. Catheter Cardiovasc Interv 66(2):192–198. https://doi.org/10.1002/ccd.20434
Ruiz-Salmeron RJ, Mora R, Velez-Gimon M et al (2005) Radial artery spasm in transradial cardiac catheterization. Assessment of factors related to its occurrence, and of its consequences during follow-up. Rev Esp Cardiol 58(5):504–511
Koga S, Ikeda S, Futagawa K et al (2004) The use of a hydrophilic-coated catheter during transradial cardiac catheterization is associated with a low incidence of radial artery spasm. Int J Cardiol 96(2):255–258. https://doi.org/10.1016/j.ijcard.2003.07.016
Hildick-Smith DJ, Walsh JT, Lowe MD, Shapiro LM, Petch MC (2004) Transradial coronary angiography in patients with contraindications to the femoral approach: an analysis of 500 cases. Catheter Cardiovasc Interv 61(1):60–66. https://doi.org/10.1002/ccd.10708
Kiemeneij F, Vajifdar BU, Eccleshall SC, Laarman G, Slagboom T, van der Wieken R (2003) Evaluation of a spasmolytic cocktail to prevent radial artery spasm during coronary procedures. Catheter Cardiovasc Interv 58(3):281–284. https://doi.org/10.1002/ccd.10445
Saito S, Tanaka S, Hiroe Y et al (2002) Usefulness of hydrophilic coating on arterial sheath introducer in transradial coronary intervention. Catheter Cardiovasc Interv 56(3):328–332. https://doi.org/10.1002/ccd.10202
Hizoh I, Majoros Z, Major L et al (2014) Need for prophylactic application of verapamil in transradial coronary procedures: a randomized trial. The VITRIOL (is verapamil in TransRadial interventions OmittabLe?) trial. J Am Heart Assoc 3(2):e000588. https://doi.org/10.1161/JAHA.113.000588
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
This article does not contain any studies with human participants or animals performed by any of the authors.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Khan, M.Z., Patel, K., Franklin, S. et al. Radial artery spasm: reviews and updates. Ir J Med Sci 189, 1253–1258 (2020). https://doi.org/10.1007/s11845-020-02203-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11845-020-02203-9