Incidence Of Spasm Research Articles

The comparative efficacy and safety of Tiger II versus judkins catheters in coronary angiogram via the radial artery access: a meta-analysis

Background Trans-radial coronary angiogram (TR-CAG) has gained popularity due to lower complication rates compared to transfemoral access. Operators can use either conventional catheters, such as Judkins, or single dedicated catheters, such as Tiger-II. This meta-analysis compared the safety and efficacy of Tiger-II versus Judkins catheters in TR-CAG. Methods We searched PubMed, Web of Science, Scopus, and Cochrane Library through February 2024 for studies comparing Tiger-II and Judkins catheters in TR-CAG. Fixed- and random-effect models pooled estimates of odds ratios (ORs) and standardised mean differences (SMDs). Primary outcomes included fluoroscopy time and contrast volume. Secondary outcomes included procedural time, radiation exposure, procedural success, radial artery vasospasm, and crossover rate. Results Seven studies with 2879 patients (1799 in Tiger-II and 1080 in Judkins) were included. Tiger-II use significantly reduced fluoroscopy time (SMD = −0.50 min, 95% CI [−0.80, −0.19], p < 0.01), procedural time (MD = −2.00 min, 95% CI [−2.35, −1.66], p < 0.01), and contrast volume (MD = −7.48 ml, 95% CI [−12.66, −2.29], p < 0.01). Radial artery spasm incidence was also lower (OR = 0.30, 95% CI [0.12, 0.75], p = 0.01). There were no significant differences in radiation exposure, procedural success, or crossover rate. Conclusion Tiger-II catheters offer reduced fluoroscopy time, procedural time, contrast volume, and radial artery spasm rates in TR-CAG.

Reducing Pain, Spasm, and Vasovagal Syndrome in Transradial Cardiac Angiography: The Role of Lidocaine Cream and Injectable Lidocaine

Background: Transradial cardiac angiography offers advantages in therapeutic outcomes and economic efficiency; however, it is associated with side effects such as pain, vascular spasm, and vasovagal syndrome. Objectives: This study evaluates the efficacy of injectable lidocaine, with and without the application of topical lidocaine cream, in mitigating these adverse effects. Methods: In this single-blinded clinical trial, 80 patients aged 18 and older who referred to Shahid Modarres Hospital, Tehran, Iran, between 2022 and 2023 were enrolled. Participants met specific criteria to ensure a homogeneous study population. They were randomly assigned to receive either lidocaine cream in conjunction with a subcutaneous lidocaine injection or a placebo cream with subcutaneous lidocaine. Pain intensity was assessed using the Visual Analog Scale (VAS), and complications were recorded through pre-designed checklists. Statistical analyses were performed using SPSS version 23, employing appropriate tests to explore significant differences. Results: The mean age of participants was 58.1 years, with both groups exhibiting similar demographic characteristics. Statistical analysis indicated that the use of lidocaine cream significantly reduced pain occurrence, with none in the experimental group reporting pain compared to 7 in the control group (P = 0.006). Furthermore, lidocaine cream decreased the incidence of spasms, noted in 5 patients in the control group, with no spasms reported in the experimental group (P = 0.021). Additionally, vasovagal syndrome was significantly lower in the experimental group (P = 0.011). Conclusions: The study indicates that pre-application of lidocaine cream prior to injectable lidocaine effectively alleviates pain, vascular spasm, and vasovagal syndrome in patients undergoing transradial cardiac angiography, supporting its incorporation into routine practice to enhance patient comfort and safety.

Routine preprocedural ultrasound in palpation versus ultrasound guided radial access for cardiac catheterization.

The radial first approach in cardiac catheterization is preferred for its benefits in patient comfort and recovery time. Yet, challenges persist due to characteristics like small, deep, calcified, and mobile radial arteries. Utilizing ultrasound before and during procedures can improve success rates. However, the adoption of its use is still limited and subject to debate. To utilize routine preprocedural ultrasound (US) and compare US guided with palpation guided radial access, focusing on operator efficiency and outcomes. Consenting adult patients undergoing elective radial cardiac catheterization were divided into palpation and US groups. Routine preprocedural assessment of radial artery characteristics was performed using handheld US. Baseline data, US findings, procedural outcomes, and clinical outcomes were compared in 182 participants (91 in each group). US guided radial access had significantly higher first pass success rates (76.92% vs. 49.45%, p 0.0001), fewer number of attempts (1.46 ± 1 vs. 1.99 ± 1.46, p 0.004), and shorter amount of time (93.62 ± 44.04 vs. 120.44 ± 67.1, p 0.002) compared with palpation guidance. The palpation group hadsignificantly higher incidence of spasm (15.38% vs. 3.3%, p 0.0052). Subgroup analysis indicated consistent benefits of US guidance, especially in calcified radial arteries. This prospective, nonrandomized, single-center study demonstrated that real-time procedural US improved the operator's time and effort and enhanced patient comfort compared with palpation. US guidance use was particularly favorable in the presence of calcifications observed on baseline preoperative US.

Impact of sex differences on the feasibility and safety of distal radial access for coronary procedures: a multicenter prospective observational study.

Conventional transradial access in women is associated with a lower success rate and a higher incidence of spasm compared to men. To date, the effect of sex on the performance of distal radial access (DRA) has not been fully elucidated. The aim of this study was to assess the impact of sex on catheterization success and other performance parameters of DRA procedures. This is a prospective three-center observational study. From August 2020 to September 2022, data from all consecutive patients who underwent DRA for coronary procedures were collected. A total of 868 procedures were registered and stratified into two groups according to sex: women (n = 258) and men (n = 610). Female patients had less favorable baseline characteristics than male patients in terms of absent or weak pulse (29% vs. 17%; P < 0.001), distal radial diameter (2.2 ± 0.3 vs. 2.4 ± 0.4 mm; P < 0.001) and proximal radial diameter (2.5 ± 0.7 vs. 2.7 ± 0.7 mm; P = 0.001). No differences in success rates were found in women compared to men (94.2% vs. 96.6%; P = 0.135), with a higher presence of arterial spasm in women (5.8% vs. 3.0%; P = 0.044). The preprocedural ultrasound evaluation was the only predictor of DRA success [odds ratio = 20.0 (4.739-83.333); P < 0.001]. In patients undergoing coronary procedures, the success rate of DRA was high regardless of sex, with a higher incidence of arterial spasm in women.

Secondary prevention of cerebrovascular events in patients with “asymptomatic” atherosclerotic stenosis of the vertebral arteries

Abstract Aim To determine the feasibility of performing endovascular interventions in patients with “asymptomatic” atherosclerotic stenosis of the vertebral arteries, as a method of secondary prevention of cerebrovascular events. Material and methods The patients were randomized into 2 groups: in group I (n=78), secondary prevention of cerebrovascular events were carried out in a combined strategy - stenting of the vertebral arteries in combination with medication therapy, and in group II (n=78) - only medication therapy. Group I were randomized in 2 subgroups – Ia and Ib. In subgroup Ia (n=39) – endovascular intervention were performed with embolism protection devices, and in subgroup Ib (n=35) - embolism protection devices were not used. Long-term follow-up was planned after 12, 24 and 36 months. Inclusion criteria: “asymptomatic” stenosis of vertebral arteries 50–95%; the diameter of the vertebral arteries is not less than 3.0 and not more than 5 mm; the presence of not gross cerebral and focal symptoms corresponding to the initial (asymptomatic) stage of encephalopathy (according to E.V. Schmidt). Primary endpoint: total frequency of cerebrovascular events. Results The total incidence of spasm and dissection during endovascular intervention was 20.5% in subgroup Ia and 2.5% in subgroup Ib (p=0.0367). Also in subgroup Ia, 2 (4.5%) patients had transient ischemic attack. In subgroup Ib, perioperative cerebrovascular events was not observed. The total frequency of major cerebral complications over 36 months of follow-up was 4.5% in group 1 and 37.5% in group II (χ2=15.101; p&amp;lt;0.0001). The frequency of cardiac events was 9.1 and 19.6%, respectively, to groups I and II (χ2=14.784; p&amp;lt;0.0001). These indicators were obtained against the background of high patient adherence to treatment and high rates of achieving tough target lipid values. Restenosis of the stents was observed in general, in 18% of patients from group I, who underwent stenting of the vertebral arteries by various generations of stents. Moreover, restenosis alone did not affect the incidence of major cerebral complications in the long-term period (χ2=0.1643; p=0.735). Conclusion In spite of the development of restenosis, it is endovascular intervention in combination with drug therapy that helps to avoid the development of large cerebrovascular events arising from the instability of atherosclerotic plaque in patients with “asymptomatic” vertebral artery stenosis and is a reliable method of secondary prevention of of cerebrovascular events. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Russian academic excellence project 5-100

Immediate and long-term results of stenting of vertebral arteries in patients with asymptomatic chronic brain ischemia

Highlights. The efficiency of the endovascular treatment combined with medical therapy versus medical therapy has been proven to prevent strokes in patients with vertebral artery atherosclerotic lesions and asymptomatic chronic cerebral ischemia.Aim. To assess the efficiency of endovascular treatment in patients with asymptomatic vertebral artery atherosclerotic lesions as an approach for secondary prevention of strokes.Methods. Group 1 patients (n = 44) underwent stenting of the vertebral arteries combined with the medical therapy to prevent strokes, whereas group 2 patients (n = 56) received the medical therapy alone. Group 1 was then subdivided into two subgroups -subgroups 1a and 1b. Subgroup 1a patients underwent (n = 22) stenting using the embolic protection devices, while Subgroup 1b patients (n = 22) - embolic protection devices were not used. The follow-up was up to 36 months with regular visits at 12, 24, and 36 months. The inclusion criteria were as follows: asymptomatic vertebral artery stenosis of 50-95%; the diameter of the vertebral arteries of less than 3.0 and not more than 5 mm; the presence of cerebral and focal symptoms corresponding to asymptomatic chronic brain ischemia (according to E.V. Schmidt).Results. The overall incidence of spasm and dissection during endovascular intervention was 20% and 4.5% in Subgroup 1a and 1b, respectively (p = 0.0367). 2 (4.5%) patients had transient ischemic attack in Subgroup 1a. There were no perioperative strokes in Subgroup 1b. The overall rate of major cerebral complications over 36 months was 4.5% in Group 1 versus 37.5% in Group 2 (x2 = 15.101; p &lt;0.0001). The rate of adverse cardiac events was 9.1% and 19.6%, in Groups 1 and 2, respectively (x2 = 14.784; p &lt;0.0001). In-stent restenosis occurred in 38.67% of patients in Group I, who underwent stenting using various generations of stents. In-stent restenosis did not affect the incidence of major cerebral complications in the long-term period (x2 = 0.1643; p = 0.735).Conclusion. Endovascular treatment combined with medical therapy allowed preventing cerebral complications associated with the instability of atherosclerotic plaques in patients with asymptomatic vertebral artery stenosis. It has proved to be an effective method for the secondary prevention of strokes.

CASK related disorder: Epilepsy and developmental outcome.

CASK pathogenic variants are associated with variable features, as intellectual disability, optic atrophy, brainstem/cerebellar hypoplasia, and epileptic encephalopathy. Few studies describe the electroclinical features of epilepsy in patients with CASK pathogenic variants and their relationship with developmental delay. this national multicentre cohort included genetically confirmed patients with different CASK pathogenic variants. Our findings were compared with cohorts reported in the literature. we collected 34 patients (29 females) showing from moderate (4 patients) to severe (22) and profound (8) developmental delay; all showed pontine and cerebellar hypoplasia, all except three with microcephaly. Seventeen out of 34 patients (50%) suffered from epileptic seizures, including spasms (11 patients, 32.3%), generalized (5) or focal seizures (1). In 8/17 individuals (47.1%), epilepsy started at or beyond the age of 24 months. Seven (3 males) out of the 11 children with spasms showed EEG features and a course supporting the diagnosis of a developmental and epileptic encephalopathy (DEE). Drug resistance was frequent in our cohort (52.9% of patients with epilepsy). EEG abnormalities included poorly organized background activity with diffuse or multifocal epileptiform abnormalities and sleep-activation, with possible appearance over the follow-up period. Developmental delay degree was not statistically different among patients with or without seizures but feeding difficulties were more frequent in patients with epilepsy. epilepsy is a frequent comorbidity with a high incidence of spasms and drug resistance. Overall developmental disability does not seem to be more severe in the group of patients with epilepsy nor to be linked to specific epilepsy/EEG characteristics. A childhood onset of epilepsy is frequent, with possible worsening over time, so that serial and systematic monitoring is mandatory.

Novel combined topical gel of lidocaine–verapamil–nitroglycerin can dilate the radial artery and reduce radial pain during trans-radial angioplasty

IntroductionRadial approach for coronary angioplasty is accepted by many specialists in medical centers around the world. The use of radial access is associated with fewer vascular complications and the same success rate in comparison with traditional femoral access. Radial artery spasm is one of the main concerns in this method. The small size of the radial artery and high density of alpha-1 adrenergic receptors in this artery can accelerate the spasm. The objects of this study were to evaluate whether the combined topical gel of lidocaine–verapamil–nitroglycerin could dilate the radial artery and reduce patient pain and sympathetic response during radial puncture.MethodsPatients undergoing elective trans-radial angioplasty were randomized to either placebo or therapeutic gel group in single-center, double-blind study. Placebo or therapeutic gel applied 1 cm proximal to the radial styloid process. Radial artery size was measured by ultrasound. Radial pain was reported by the visual analog scale (VAS) and the sympathetic response was assessed by changes in systolic (SBP) and diastolic blood pressure (DBP) and heart rate (HR). The incidence of spasm was defined by the radial artery spasm score.Results60 patients (30 patients in each group) participated in this study. A significant increase in the size of the radial artery was observed in the group receiving therapeutic gel compared to the placebo group (mean diameter, mm: 2.95 ± 0.48 vs. 2.54 ± 0.43, p = 0.001; area, cm2: 0.07 vs. 0.05, p = 0.001). During radial puncture, the radial pain intensity was significantly decreased in patients receiving therapeutic gel (4 (1–5) vs. 2 (1–2), p = 0.003). Radial artery spasm didn’t happen in any group.ConclusionBased on our results, Pre-procedural administration of combined topical gel of verapamil-nitroglycerin-lidocaine significantly increases the size of the radial artery and effectively reduces the radial pain during radial puncture in patients undergoing trans-radial angioplasty.

Abstract 16146: Topical Nitroglycerine Reduces Radial Access Site Failure and Femoral Crossover - Topical Nitroglycerine to Prevent Radial Artery Spasm (TNTRASP) Study

Background: Radial to femoral access crossover has been reported as high as 7.6%. Access site failure, radial spasm and tortuosity are potential reasons. Methods: Patients undergoing radial catheterization were randomly assigned to 30 mg of topical nitroglycerine (NTG, n =48) or placebo ( n =52) at least one hour before access. Both groups received 40 mg of topical lidocaine. Radial artery dimensions were measured before drug application and immediately before access. RASP score (Forearm discomfort + Difficult catheter manipulation + Additional intraarterial NTG + Sheath removal difficulty) &gt;0 indicates radial spasm. Results: Radial artery cross sectional area (CSA) increased significantly in NTG group (30% vs. -3%, p &lt;0.001). Radial artery was smaller than the sheath at time of access in fewer patients in NTG group (10% vs. 27%, p &lt;0.05). Fewer patients had spasm in NTG group (17% vs. 29%, p =0.14). Average RASP score was lower in NTG group (0.2 vs. 0.6, p =0.10). No crossover to femoral access in NTG group compared to 4 crossovers in control ( p &lt;0.05). Femoral crossover was 10 times more likely if radial diameter &lt; 2 mm ( p &lt;0.05). Risk of radial spasm was higher with multiple arterial sticks ( p &lt;0.01); arterial tortuosity ( p &lt;0.05); intraarterial heparin ( p &lt;0.01), use of multiple wires ( p &lt;0.001); use of multiple catheters ( p &lt;0.01) and nonhydrophillic catheter use ( p =0.001). Preprocedural valium reduced risk of radial spasm. Radial spasm was associated with 5 fold risk of hematoma ( p =0.01) and higher radiation dose ( p &lt;0.001). Discussion: Pre-dilation with topical NTG reduced access site failure and risk of femoral crossover. Radial spasm incidence was lower in NTG but not statistically significant. Radial spasm was influenced by several factors like choice of wires and catheters. Radial spasm increased risk of hematoma as well as radiation exposure. Conclusion: Topical nitroglycerine to predilate radial artery reduces risk of femoral crossover and may reduce radial spasm.

Pharmacological spasm provocation testing in 2500 patients: provoked spasm incidence, complications and cardiac events

Pharmacological spasm provocation tests such as acetylcholine (ACh) and ergonovine (ER) had been performed in the clinic. We retrospectively analyzed the incidence of provoked spasm, complications during testing and the cardiac events after these tests. From January 1991 and October 2018, we performed pharmacological spasm provocation tests in 2500 patients: 1810 ACh tests, 1232 ER tests, 542 both tests, and 310 ACh added after ER tests. ACh was injected in incremental doses of 20/50/100/200μg into the LCA and 20/50/80μg into the RCA. ER was administered as a total dose of 64μg into the LCA and 40μg into the RCA. When adding ACh after ER, the total dose was 50/80μg into the RCA and 100/200μg into the LCA. Positive spasm was defined as ≥ 90% stenosis and usual chest pain or ischemic ECG changes. Mean follow-up duration was 47.5 ± 29.9months. Overall, provoked positive spasm was found in 1095 patients (43.8%). The incidence of positive provoked spasm during ACh testing was significantly higher than that during other tests (ACh: 48.7% vs. ER: 28.9%, Both: 24%, ACh added after ER: 33.5%, p < 0.001). Multiple spasms were remarkably more frequent during ACh testing compared with the other 3 types of testing (ACh: 28.2% vs. ER: 7.4%, Both: 4.1%, ACh added after ER: 13.2%, p < 0.001). No death or acute myocardial infarction was observed, while major complications during ACh testing were significantly more frequent than during ER testing. Readmission due to recurrent angina pectoris in spasm-positive patients was remarkably more frequent than in spasm-negative patients. The incidence of sudden cardiac death, ventricular fibrillation, and acute coronary syndrome were not different between the spasm-positive and spasm-negative groups during the follow-up periods. We could perform all spasm provocation tests without any irreversible complications. All sequential spasm provocation tests were useful for documenting coronary spasm.

Feasibility of single catheter intervention for multivessel coronary artery disease using transradial approach.

The objective of the study was to describe the feasibility of single catheter intervention using the transradial approach for percutaneous coronary intervention (PCI). The transradial approach for PCIs has fewer vascular events and complications and lower mortality rate. However, complications can result from forearm artery tortuosity, a longer learning curve and artery spasm that can complicate, delay and impede coronary artery interventions. The latter is usually exacerbated by the changing and manipulation of catheters. We performed a study using a single catheter on patients undergoing coronary assessment and treatment. Procedural outcomes including success, procedural time, bleeding, access site complications, and contrast used were all analyzed. We included 327 patients, of whom 70% were male. The mean age was 63.3 ± 11.1 years, mean height was 165.9 ± 7.7 cm, mean weight was 73.3 ± 11.3 kg, and mean body index was 26.5 ± 3.5 kg/m2. Contrast use averaged 158.5 ± 60.5 ml. Three vessels were treated in 3% of all cases, two vessels in 32%, and one vessel in 65%. Procedural success was achieved in 94.5% of the cases. A second catheter was required in 9 cases (2.7%), and crossover to the femoral approach was performed in 9 cases (2.7%) due to a lack of support, artery spasm, difficult anatomy, or the need for a larger catheter. Three complications were related to access, including a Class 2 hematoma that was treated conservatively with no further complications. Our study showed that using a single catheter to perform both diagnostic and therapeutic procedures has a higher success rate, lower spasm incidence, and fewer complications than reported in literature.

Clinical characteristics in patients with rest angina and hypoplastic right coronary artery.

Hypoplastic coronary artery disease is a rare congenital abnormality reported to be associated with myocardial infarction and sudden cardiac death. Provoked positive spasm in the left circumflex coronary artery (LCX) with pharmacological spasm provocation tests was remarkably lower than other coronary arteries. We sometimes encountered patients with rest angina and hypoplastic right coronary artery (H-RCA). Among 5953 patients with diagnostic and follow-up coronary arteriography, we found 93 patients (1.6%) with H-RCA. During the same period, we could perform spasm provocation tests in 564 patients with rest angina including 13 patients with H-RCA and 249 patients with effort angina including 10 patients with H-RCA. Pharmacological spasm provocation tests were performed in 51 of 93 patients including 34 patients with ischemic heart disease (IHD) and 17 patients with non-IHD. Provoked spasm incidence in patients with IHD was higher than in those with non-IHD but not significant (52.9% vs. 29.4%, p = 0.1114). Provoked positive spasm in the LCX in patients with rest angina and H-RCA was significantly higher than that in those without H-RCA (69.2% vs. 23.4%, p < 0.001). Provoked spasm on both left anterior descending artery and LCX in patients with rest angina and H-RCA was also remarkably higher than in those without H-RCA (53.8% vs. 3.1%, p < 0,001). There were no clinical differences between patients with and without H-RCA rest angina. Two-vessel spasm (61.5% vs. 0%, p < 0.01) and LCX-provoked spasm (69.2% vs. o%, p < 0.01) were significantly higher in patients with H-RCA and rest angina than that in those with H-RCA and effort angina. In patients with rest angina and H-RCA, LCX-positive spasm was significantly higher and these patients may have a potential of high disease activity in the clinic as a coronary spastic angina.

Recovery with Propofol Anesthesia in Children Undergoing Cleft Palate Repair Compared with Sevoflurane Anesthesia

BackgroundNowadays, propofol total intravenous anesthesia (propofol TIVA) is a very attractive choice for routine pediatric anesthesia practice.ObjectivesTo compare propofol- vs. sevoflurane-based anesthesia for pediatrics undergoing cleft palate repair in emergence characteristics and respiratory adverse effects.MethodsEighty infants, aged from six months to one year, scheduled for cleft palate repair surgery, were randomly divided into two groups (40 patients each). The group I received general anesthesia induced with intravenous propofol 2.5 mg/kg, 0.1 mg/kg of lidocaine, fentanyl one µg/kg and cisatracurium 0.15 mg/kg, and maintained by a continuous infusion of propofol 9 mg/kg/hr and cisatracurium 3 µg/kg/hr. While in the group II, general anesthesia induced by O2/sevoflurane, intravenous fentanyl one µg/kg and cisatracurium 0.15 mg/kg then the maintenance was carried out by O2/air, sevoflurane 2 MAC, and cisatracurium three µg/kg/hr. Postoperative FLACC behavioral pain assessment Scale, modified Hannallah score, postoperative laryngeal spasm incidence, the recovery time, time to extubation, and postoperative complication were recorded.ResultsThe quality of emergence was assessed by modified Hannallah score, there was a significant decrease in the number of patients developed agitation after propofol TIVA in comparison to sevoflurane anesthesia (P < 0.001) with a significant decrease in the number of patients developed postoperative laryngeal spasm (P < 0.047). On the other hand, a significantly prolonged time of extubation was observed in the propofol TIVA group (P < 0.001).ConclusionsPropofol TIVA regimen was the more peaceful recovery approach with less perioperative respiratory complications than sevoflurane-based anesthesia in infants undergoing cleft palate repair surgery.

Validation of a Predictive Score for Radial Artery Spasm in Patients Undergoing Elective Transradial Percutaneous Coronary Procedures

BACKGROUND: Radial artery spasm (RAS) is one of the most common complications during transradial coronary procedures and can increase access-site-related adverse events. There is no standard tool to determine patients at high risk of RAS who would benefit from intensive spasm preventive measures. This study aims to validate a RAS risk score in patients undergoing elective transradial coronary procedures. METHODOLOGY: The study population consisted of a prospective cohort of patients who underwent elective transradial coronary angiography and PCI (n=210). A RAS risk score was used to classify patients as high or low risk. Spasm incidence was recorded and the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of the RAS risk score were determined. RESULTS: RAS incidence was 11.43%. A greater number of patients who had RAS were females (p=0.023), weighed less (64.4 ± 9.20 kg, p=0.0353), had lower body mass index (BMI) (19.9 ± 2.33, p=0.0512), were current smokers (p=0.031) and had peripheral artery disease (PAD) (p&lt;001). The RAS risk score had a sensitivity of 87.50%, a specificity of 76.34%, PPV of 32.31%, NPV of 97.93% and accuracy of 77.62% with c-statistic of 0.8685. CONCLUSION: The RAS risk score may be a good tool to identify patients at high risk of RAS during elective transradial coronary procedures in whom more intensive spasm-preventive measures can possibly lead to a significant reduction in the frequency of RAS and potentially reduce access-site-related adverse events. KEYWORDS: Radial artery spasm, radial artery spasm risk score, predictor of radial artery spasm

Radial artery access site complications during cardiac procedures, clinical implications and potential solutions: The role of nitric oxide.

Percutaneous coronary intervention for the treatment of coronary artery disease is most commonly performed in the UK through the radial artery, as this is safer than the femoral approach. However, despite improvements in technology and techniques, complications can occur. The most common complication, arterial spasm, can cause intense pain and, in some cases, procedural failure. The incidence of spasm is dependent on several variables, including operator experience, artery size, and equipment used. An anti-spasmolytic cocktail can be applied to reduce spasm, which usually includes an exogenous nitric oxide (NO) donor (glyceryl trinitrate). NO is an endogenous local vasodilator and therefore is a potential target for anti-spasm intervention. However, systemic administration can result in unwanted side-effects, such as hypotension. A method that adopts local delivery of NO might be advantageous. This review article describes the mechanisms involved in radial artery spasm, discusses the advantages and disadvantages of current strategies to reduce spasm, and highlight the potential of NO-loaded nanoporous materials for use in this setting.

Long-term outcomes of aCaucasian cohort presenting with acute coronary syndrome and/or out-of-hospital cardiac arrest caused by coronary spasm.

BackgroundCoronary artery spasm may be the underlying mechanism in up to 10% of cases of acute coronary syndrome (ACS) and sudden cardiac death. Asian individuals exhibit a 3-times greater incidence of spasm than Caucasians; this is likely due to different types of mechanisms. Consequently, solid data is limited about the long-term prognosis in Caucasian patients presenting with ACS and/or out-of-hospital cardiac arrest (OHCA) caused by coronary spasm.MethodsBetween 2002 and 2015, thirty Caucasian patients with coronary artery spasm presenting with ACS (N = 29) and/or OHCA (N = 11) were enrolled in this prospective registry. Follow-up, consisting of regular outpatient visits, was conducted with a mean follow-up period of 7.5 ± 3.3 years. Outcomes included presence of stable angina pectoris, recurrence of ACS, occurrence of implantable cardioverter defibrillator (ICD) shocks and death.ResultsThe majority of patients (60%) remained asymptomatic during the entire follow-up period. At the end of the follow-up period only 3 patients still experienced stable angina (10%). Only 2 patients (7%) had a recurrent cardiac event, in which the ICD provided appropriate shock therapy. Half of the patients treated with stenting (N = 6), required re-interventions.ConclusionCoronary spasm with ACS and/or OHCA in a Caucasian patient cohort has a relatively benign prognosis in the majority of patients in long-term follow-up, if treated appropriately with medical therapy. Both the role of ICD in OHCA secondary to coronary spasm, and the efficacy of stenting to treat vasospastic angina, warrant further study in large-sized prospective clinical trials.

Procedural sedation during transradial coronary angiography to prevent spasm.

Radial artery spasm is common during transradial procedures and is the most common cause of procedural failure. The objectives of this study were to assess whether the routine administration of sedation at the beginning of transradial coronary angiography with the use of hydrophilic-coated and smaller sheaths/catheters would reduce the incidence of radial artery spasm. Patients undergoing transradial coronary angiography were prospectively randomized to receive midazolam during the procedure or no sedative treatment. The primary endpoint was angiographically confirmed radial artery spasm. Stenosis of the radial artery was measured with a computer-assisted quantification method. In all, 150 patients were randomized into a treatment group and a control group. Spasm occurred in 15 patients of the treatment group (20 %) versus 16 in the control group (21.3 %). There were no differences between the two groups regarding the incidence of spasm and the distribution of spasm severity (p > 0.05). No significant differences were observed between the two groups in terms of 30-day mortality or repeat hospitalization for any cause (p > 0.05). Routine use of midazolam could not reduce the occurrence of radial artery spasm during transradial coronary angiography.

The effects of inosine on clinical and histological findings after experimental spinal cord injury in rats

Inosine is a naturally occurring purine nucleoside, the effect of which was discovered only in recent decades. It has potential to prevent neuronal and glial death and can stimulate axonal outgrowth. This study evalu - ated the effect of inosine (400 mg per rat) administered orally two hours after experimental spinal cord injury and continuously daily for 12 days. We observed the effect of inosine on clinical and histological changes by means of measurement of recovery of hind leg motor function and urinary bladder function, frequency of spasms, neu - ronal profile and spinal cord tissue sparing. The rats were randomly divided into three groups, SCI-Aqua and SCI-Inosine, with daily administration of aqua for injection or inosine, and SCI-Sham group without spinal injury. The motor function of hind legs and urinary bladder function were evaluated daily for 12 days after the spinal cord injury. In the SCI-Inosine group we recorded lower incidence of spasms due to spinal cord irritation in the early postoperative period when compared to the SCI-Aqua group. We used immunohistochemistry with specific neuronal antibodies to determine the neuronal profiles and the Luxol fast blue staining method to detect the white and grey matter tissue sparing. In our study we recorded significant differences in recovery between the SCI-Aqua and SCI-Inosine group from eigth days after surgery. Moreover, the post mortem investigation of transverse spinal cord sections revealed significantly higher numbers in the SCI-Inosine group (more neurons, greater tissue spar - ing). According to our findings inosine accelerates the recovery of neurological functions.

TCT-269 RAS Registry, Real world incidence of Spasm in Trans radial Intervention

TCT-269 RAS Registry, Real world incidence of Spasm in Trans radial Intervention

Circulation: Clinical Summaries

<i>Circulation:</i> Clinical Summaries