The incidence of post procedure radial occlusion (RAO) ranges from 1% to 12 % according to some studies. Different strategies to reduce RAO include the use of small caliber catheters, adequate anticoagulation and punction site care after procedure.
Vasodilators are used to prevent radial spasm during procedure. However, using it after procedure should increase flow, improving hemostasis, and preventing RAO.
The aim of this prospective, multicenter, randomized, double blind study was to assess whether the administration of nitroglycerin at the beginning or at the end of procedure might preserve radial artery patency compared against placebo.
Primary end point was early RAO incidence confirmed by ultrasound up to 24 hrs. after procedure. Secondary end point was late RAO (30 days after procedure).
It included 2040 patients. Mean age was 61 and 38% were women. The right radial artery was the most used (99.9%), and catheterization was the most frequent diagnostic procedure.
There were no significant differences when looking at primary and secondary end points. The presence of recanalization at 30 days assessed by Doppler was 30% with no differences between the groups.
At multivariable analysis, the presence of radial spasm and access achieved with more than one puncture attempt were independent predictors of RAO at 24 hrs.
Conclusion
The use of nitroglycerin was not associated with reduced RAO rate, regardless of time of administration, and therefore it should not be considered mandatory to prevent this complication.
Dr. Andrés Rodríguez.
Member of the Editorial Board in SOLACI.org .
Original Title: Randomized Clinical Trial on Prevention of Radial Occlusion After Transradial Access Using Nitroglycerin PATENS Trial.
Reference: Roberto L. da Silva, MD et al J Am Coll Cardiol Intv 2022.
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