Topical Nitroglycerin for Radial Access Optimization: Supporting Vascular Access in Patients at Risk for Acute Heart Failure
<i>Background and Objectives</i>: Radial artery spasm (RAS) is a frequent complication during invasive angiography using the transradial approach, leading to patient discomfort and procedural challenges. While intra-arterial nitroglycerine (NTG) effectively reduces RAS after sheath inser...
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MDPI AG
2025-05-01
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| Online Access: | https://www.mdpi.com/1648-9144/61/6/1016 |
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| author | Adrian Sebastian Zus Simina Crișan Silvia Luca Daniel Nișulescu Mihaela Valcovici Oana Pătru Mihai-Andrei Lazăr Cristina Văcărescu Dan Gaiță Constantin-Tudor Luca |
| author_facet | Adrian Sebastian Zus Simina Crișan Silvia Luca Daniel Nișulescu Mihaela Valcovici Oana Pătru Mihai-Andrei Lazăr Cristina Văcărescu Dan Gaiță Constantin-Tudor Luca |
| author_sort | Adrian Sebastian Zus |
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| description | <i>Background and Objectives</i>: Radial artery spasm (RAS) is a frequent complication during invasive angiography using the transradial approach, leading to patient discomfort and procedural challenges. While intra-arterial nitroglycerine (NTG) effectively reduces RAS after sheath insertion, preprocedural prevention strategies are limited. This study evaluates the efficacy of topical NTG in improving radial artery puncture success and reducing RAS incidence. <i>Materials and Methods:</i> In a randomized, double-blind single-center study 100 patients undergoing angiography were pretreated with either topical NTG or placebo. Outcomes assessed included RAS incidence, radial artery puncture success, number of attempts, procedural duration, patient discomfort, and complications. RAS was evaluated angiographically and clinically, with additional subgroup analyses for diabetic and smoking patients. <i>Results</i>: Topical NTG significantly reduced RAS incidence (53.2% vs. 73.6%; <i>p</i> = 0.0349) and increased radial puncture success on the first attempt (89.4% vs. 77.4%; <i>p</i> = 0.0488). Diabetic patients particularly benefited from NTG application, with lower RAS rates (36.4% vs. 76.2%; <i>p</i> = 0.0296). No significant differences were observed in procedural duration, patient discomfort, or complication rates between groups. The placebo group demonstrated a higher incidence of diffuse RAS (<i>p</i> = 0.0109). <i>Conclusions:</i> Preprocedural topical NTG application is a safe, non-invasive intervention that improves radial artery access success and reduces RAS, especially in high-risk subgroups such as diabetics. These findings support its potential as a procedural optimization tool in cardiovascular interventions, particularly in patients with heart failure, who often require repeated and reliable vascular access. |
| format | Article |
| id | doaj-art-d217c9150d364ff4922ecdf504761bcb |
| institution | Kabale University |
| issn | 1010-660X 1648-9144 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj-art-d217c9150d364ff4922ecdf504761bcb2025-08-20T03:27:25ZengMDPI AGMedicina1010-660X1648-91442025-05-01616101610.3390/medicina61061016Topical Nitroglycerin for Radial Access Optimization: Supporting Vascular Access in Patients at Risk for Acute Heart FailureAdrian Sebastian Zus0Simina Crișan1Silvia Luca2Daniel Nișulescu3Mihaela Valcovici4Oana Pătru5Mihai-Andrei Lazăr6Cristina Văcărescu7Dan Gaiță8Constantin-Tudor Luca9Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, RomaniaCardiology Department, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, RomaniaCardiology Department, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, RomaniaInstitute of Cardiovascular Diseases Timisoara, 300310 Timisoara, RomaniaCardiology Department, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, RomaniaCardiology Department, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, RomaniaCardiology Department, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, RomaniaCardiology Department, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, RomaniaCardiology Department, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, RomaniaCardiology Department, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania<i>Background and Objectives</i>: Radial artery spasm (RAS) is a frequent complication during invasive angiography using the transradial approach, leading to patient discomfort and procedural challenges. While intra-arterial nitroglycerine (NTG) effectively reduces RAS after sheath insertion, preprocedural prevention strategies are limited. This study evaluates the efficacy of topical NTG in improving radial artery puncture success and reducing RAS incidence. <i>Materials and Methods:</i> In a randomized, double-blind single-center study 100 patients undergoing angiography were pretreated with either topical NTG or placebo. Outcomes assessed included RAS incidence, radial artery puncture success, number of attempts, procedural duration, patient discomfort, and complications. RAS was evaluated angiographically and clinically, with additional subgroup analyses for diabetic and smoking patients. <i>Results</i>: Topical NTG significantly reduced RAS incidence (53.2% vs. 73.6%; <i>p</i> = 0.0349) and increased radial puncture success on the first attempt (89.4% vs. 77.4%; <i>p</i> = 0.0488). Diabetic patients particularly benefited from NTG application, with lower RAS rates (36.4% vs. 76.2%; <i>p</i> = 0.0296). No significant differences were observed in procedural duration, patient discomfort, or complication rates between groups. The placebo group demonstrated a higher incidence of diffuse RAS (<i>p</i> = 0.0109). <i>Conclusions:</i> Preprocedural topical NTG application is a safe, non-invasive intervention that improves radial artery access success and reduces RAS, especially in high-risk subgroups such as diabetics. These findings support its potential as a procedural optimization tool in cardiovascular interventions, particularly in patients with heart failure, who often require repeated and reliable vascular access.https://www.mdpi.com/1648-9144/61/6/1016topical nitroglycerineradial artery spasmtransradial accesscoronary angiographyheart failurenitric oxide |
| spellingShingle | Adrian Sebastian Zus Simina Crișan Silvia Luca Daniel Nișulescu Mihaela Valcovici Oana Pătru Mihai-Andrei Lazăr Cristina Văcărescu Dan Gaiță Constantin-Tudor Luca Topical Nitroglycerin for Radial Access Optimization: Supporting Vascular Access in Patients at Risk for Acute Heart Failure Medicina topical nitroglycerine radial artery spasm transradial access coronary angiography heart failure nitric oxide |
| title | Topical Nitroglycerin for Radial Access Optimization: Supporting Vascular Access in Patients at Risk for Acute Heart Failure |
| title_full | Topical Nitroglycerin for Radial Access Optimization: Supporting Vascular Access in Patients at Risk for Acute Heart Failure |
| title_fullStr | Topical Nitroglycerin for Radial Access Optimization: Supporting Vascular Access in Patients at Risk for Acute Heart Failure |
| title_full_unstemmed | Topical Nitroglycerin for Radial Access Optimization: Supporting Vascular Access in Patients at Risk for Acute Heart Failure |
| title_short | Topical Nitroglycerin for Radial Access Optimization: Supporting Vascular Access in Patients at Risk for Acute Heart Failure |
| title_sort | topical nitroglycerin for radial access optimization supporting vascular access in patients at risk for acute heart failure |
| topic | topical nitroglycerine radial artery spasm transradial access coronary angiography heart failure nitric oxide |
| url | https://www.mdpi.com/1648-9144/61/6/1016 |
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