Radial artery spasm: reviews and updates
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REVIEW ARTICLE
Radial artery spasm: reviews and updates Muhammad Zubair Khan 1 & Krunalkumar Patel 1 & Sona Franklin 1 & Aradh Faruqi 2 & Waqar Ahmad 3 & Jamaluddin Saeed 3 Received: 22 December 2019 / Accepted: 10 February 2020 # Royal Academy of Medicine in Ireland 2020
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. Keywords Percutaneous coronary intervention . Radial artery spasm . Radial cocktails . Transradial access
Introduction
Definition of RAS
Transradial access (TRA) has gained popularity as they are also associated with a low procedural cost, decreased length of hospitalization, and rapid ambulation post-procedure in comparison with the transfemoral approach [1–3]. Additional advantages of the TRA are a reduced risk of bleeding, absence of major vessels or nerve structures surrounding the radial artery, and dual arterial supply to the hand (through the ulnar and radial arteries). Radial artery spasm (RAS) is a frequent complication of the TRA in elective and emergent coronary intervention that can result in severe pain and possible failure of the procedure [4, 5]. Radial artery occlusion, perforation, and formation of hematoma are rare complications [6]. In this review, we are discussing the incidence, predisposing factors, preventions, efficacy, and safety of radial cocktail, as well as management of RAS.
RAS is clinically defined as pain/discomfort in the forearm detected by the patient as the catheter is inserted/manipulated or with the withdrawal of the catheter sheath [7]. According to RAS registry, RAS can be divided based on the severity of symptoms during catheter movement and/or immediate postprocedure period: mild (minimal local pain/ discomfort); moderate (significant local pain/discomfort); severe (severe local pain during catheter movement compelling the operator to stop the procedure and cross-over to the other route); very severe (severe local pain and discomfort associated with catheter trapping) [8] [9, 10].
* Muhammad Zubair Khan [email protected] 1
Department of Internal Medicine, St Mary Medical Center, 1201 Langhorne-Newtown Rd, Langhorne, PA 19047, USA
2
Department of Cardiology, University of Virginia, Charlottesville, VA, USA
3
Department of Internal Medicine, Khyber Teaching Hospital, Peshawar, Khyber Pakhtunkhwa, Pakistan
Incidence The incidence of RAS varies (Table 1) depending on the sheath or catheter types, radial cocktail types, study population, the definition of RAS, and the expertise of the operator. In previous literature, the incidence of RAS has been reported to be 6.8
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