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Transradial Intracoronary Spasm Provocation Test

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Transradial Approach for Percutaneous Interventions

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Abstract

An important cause of pain with normal coronary vessels is coronary artery spasm (CAS). Undiagnosed coronary artery spasm can lead to significant cardiovascular morbidity and mortality. Many of these patients endure recurrent angina in spite of optimal medical therapy, causing impairment to their quality of life. In addition, this has profound impact on the cost of healthcare as many of these patients have repeated hospital admissions or multiple visits to the healthcare professionals.

According to numerous publications, half of the symptomatic patients undergoing coronary angiography revealed normal or non-obstructive coronary arteries, despite coronary angiography being the gold standard for assessing coronary arteries (Sharaf et al. Am J Cardiol 87:937–941, 2001). The transient nature of coronary artery spasm may explain the difficulty in diagnosing this vasospastic syndrome in conventional angiography study. A provocative diagnostic strategy has been used in several centres to induce vasospasm during coronary angiography. There are many pharmacological and non-pharmacological agents that had been studied in the past. Although the use provocation test is limited due to scarcity of clinical evidence or safety study, several agents have been used in some cardiac centres especially in Korea and Japan. Acetylcholine (Ach) and Ergonovine (Erg) are two agents that are more widely used in these centers. There is no published guideline available for the provocation test, but centre specific-protocols have been established, individualized and published. Transradial route has been seen as advantageous due to its lower risk for access site complications, slender system for quick recovery, shorter procedure time and convenience for both physician and patients.

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  1. Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea

    Seung-Woon Rha & Harris Abdullah Ngow

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Correspondence to Seung-Woon Rha .

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  1. Beijing, China

    Yujie Zhou

  2. Amsterdam, The Netherlands

    Ferdinand Kiemeneij

  3. Kanagawa, Japan

    Shigeru Saito

  4. Beijing Anzhen Hospital, Beijing, China

    Wei Liu

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Rha, SW., Ngow, H.A. (2017). Transradial Intracoronary Spasm Provocation Test. In: Zhou, Y., Kiemeneij, F., Saito, S., Liu, W. (eds) Transradial Approach for Percutaneous Interventions. Springer, Dordrecht. https://doi.org/10.1007/978-94-017-7350-8_26

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