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Radial arter yoluyla yapılan elektif koroner anjografi sırasında radial sheat içerisinden yapılan nitrogliserin dozu ile radial arter spazmının ilişkisi

Year 2023, Volume: 5 Issue: 3, 216 - 220, 10.10.2023
https://doi.org/10.52827/hititmedj.1334133

Abstract

Amaç: Koroner girişimlerde transradial yaklaşım, daha düşük vasküler komplikasyon oranları, azalan işlem maliyetleri ve daha erken hasta mobilizasyonu nedeniyle giderek daha popüler hale gelmektedir. Transradial yaklaşımda radial arter spazmı çözülmesi gereken önemli problemlerin başında gelmektedir. Radial arter spazmın azaltılmasında kalsiyum kanal blokerleri, nitratlar ve moksidosin gibi çeşitli vazodilatörlerin damar içine uygulamasıyla azaltılabileceği gösterilmiştir. Transradial yaklaşımda kullanılan nitrogliserin dozu ile ilgili net bir veri olmamakla birlikte, çalışmalarda damar içine doz olarak 100 mcg- 500 mcg dozlar kullanılmıştır. Biz çalışmamızda elektif koroner anjiografi yapılan hastalarda farklı nitrat dozları ile radial arter spazmı ve işlem sırasında gelişen hipotansiyon ilişkisini değerlendirdik.
Gereç ve Yöntem: Bu retrospektif araştırmaya hastanemiz katater laboratuarında transradial yaklaşım ile koroner anjografi yapılan ve medikal takip kararı verilen hastalar dahil edilmiştir. Belirlenen hastalar radial sheat yerleştirildikten sonra 200 mcg ve 300 mcg nitrogliserin verilenler olarak iki gruba ayrıldı. Sonuç olarak iki grup arası radial arter spazm oranları değerlendirilerek, verilen nitrogliserin dozu ile radial arter spazmı arasında ilişki incelendi.
Bulgular: Çalışmamıza dahil edilen, 133 hastanın yaş ortalaması 61 ± 10,8 yıl olarak saptanmıştır ve çalışmaya dahil edilen hastaların %43’ü kadın olarak izlenmiştir. Radial arter spazmı, 200 mcg nitrogliserin yapılan hastalarda 300 mcg nitrogliserin yapılanlara göre anlamlı düzeyde yüksek bulundu (%16,1-%4,2; p= 0.03). Bu iki grup arasında hipotansiyon gelişmesi açısından anlamlı fark yoktu. Çok değişkenli lojistik regresyon analizinde nitrogliserin dozunun ve açlık glukozunun radial arter spazmın bağımsız belirleyicileri olduğunu gösterildi (p<0,05).
Sonuç: Çalışmamızda transradial yaklaşım öncesi sheat içinden damar içine 200 mcg nitrogliserin yerine 300 mcg nitrogliserin verilerek, radial arter spazm etkin bir şekilde azaltılmıştır. Bu hastalarda işlem esnasında anlamlı bir hipotansiyon da gelişmemiştir.

References

  • Kiemeneij F, Laarman GJ, Slagboom T, van der Wieken R. Outpatient coronary stent implantation. J Am Coll Cardiol 1997;29(2):323-327.
  • Mann T, Cubeddu G, Bowen J, et al. Stenting in acute coronary syndromes: a comparison of radial versus femoral access sites. J Am Coll Cardiol 1998;32(3):572-576.
  • Mehta SR, Jolly SS, Cairns J, et al. Effects of radial versus femoral artery access in patients with acute coronary syndromes with or without ST-segment elevation. J Am Coll Cardiol 2012;60(24):2490-2499.
  • Varenne O. How to prevent & to manage radial artery spasm during coronary interventions? Indian Heart J 2010;62(3):230-233.
  • Wagener JF, Rao SV. Radial artery occlusion after transradial approach to cardiac catheterization. Curr Atheroscler Rep 2015;17(3):489.
  • Kristic I, Lukenda J. Radial artery spasm during transradial coronary procedures. J Invasive Cardiol 2011;23(12):527-531.
  • Lo TS, Nolan J, Fountzopoulos E, et al. Radial artery anomaly and its influence on transradial coronary procedural outcome. Heart 2009;95(5):410-415.
  • Curtis E, Fernandez R, Lee A. The effect of vasodilatory medications on radial artery spasm in patients undergoing transradial coronary artery procedures: a systematic review. JBI Database System Rev Implement Rep 2017;15(7):1952-1967.
  • Abdelazeem B, Abuelazm MT, Swed S, et al. The efficacy of nitroglycerin to prevent radial artery spasm and occlusion during and after transradial catheterization: A systematic review and meta-analysis of randomized controlled trials. Clin Cardiol 2022;45(12):1171-1183.
  • De Luca G, Schaffer A, Wirianta J, Suryapranata H. Comprehensive meta-analysis of radial vs femoral approach in primary angioplasty for STEMI. Int J Cardiol 2013;168(3):2070-2081.
  • Kwok CS, Rashid M, Fraser D, Nolan J, Mamas M. Intra-arterial vasodilators to prevent radial artery spasm: a systematic review and pooled analysis of clinical studies. Cardiovasc Revasc Med 2015;16(8):484-490.
  • Brownlee,M. Biochemistry and molecular cell biology of diabetic complications. Nature 2001;414(6865):813-820.
  • Kofler S, Nickel T, Weis M. Role of cytokines in cardiovascular diseases: a focus on endothelial responses to inflammation. Clin Sci (Lond) 2005;108(3):205-213.

The Relationship Between the Dose of Nitroglycerin Administered through the Radial Sheath and Radial Artery Spasm During Elective Coronary Angiography via the Radial Artery

Year 2023, Volume: 5 Issue: 3, 216 - 220, 10.10.2023
https://doi.org/10.52827/hititmedj.1334133

Abstract

Objective: Transradial approach in coronary interventions is becoming increasingly popular due to its lower rates of vascular complications, reduced procedural costs, and earlier patient mobilization. Radial artery spasm is a significant issue that needs to be addressed during transradial approach. Various vasodilators such as calcium channel blockers, nitrates, and moxisylyte have been shown to reduce radial artery spasm when administered intra-arterially. While no clear data exists on the nitroglycerin dosage used in transradial approach, studies have utilized doses ranging from 100 mcg to 500 mcg. This study evaluated the relationship between different nitrate dosages and radial artery spasm and procedural hypotension in patients undergoing elective coronary angiography.
Material and Method: This retrospective study included patients who underwent coronary angiography with transradial approach in our hospital’s catheter laboratory and were discharged with medical follow-up. The selected patients were divided into two groups based on the dose of nitroglycerin administered: 200 mcg and 300 mcg after radial sheath placement. The incidence of radial artery spasm between the two groups was compared, and the relationship between the administered nitroglycerin dose and radial artery spasm was analyzed.
Results: The study included 133 patients with an average age of 61 ± 10.8 years, and 43% of the patients were female. Radial artery spasm was significantly higher in patients receiving 200 mcg of nitroglycerin than those receiving 300 mcg (16.1% vs. 4.2%, p= 0.03) . There was no significant difference in the occurrence of hypotension between the two groups. Multivariate logistic regression analysis indicated that the nitroglycerin dose and fasting glucose were independent predictors of radial artery spasm (p<0.05).
Conclusion: In our study, the intra-arterial administration of 300 mcg nitroglycerin, as opposed to 200 mcg, effectively reduced radial artery spasm before transradial approach. Moreover, significant hypotension did not occur during the procedure in these patients.

References

  • Kiemeneij F, Laarman GJ, Slagboom T, van der Wieken R. Outpatient coronary stent implantation. J Am Coll Cardiol 1997;29(2):323-327.
  • Mann T, Cubeddu G, Bowen J, et al. Stenting in acute coronary syndromes: a comparison of radial versus femoral access sites. J Am Coll Cardiol 1998;32(3):572-576.
  • Mehta SR, Jolly SS, Cairns J, et al. Effects of radial versus femoral artery access in patients with acute coronary syndromes with or without ST-segment elevation. J Am Coll Cardiol 2012;60(24):2490-2499.
  • Varenne O. How to prevent & to manage radial artery spasm during coronary interventions? Indian Heart J 2010;62(3):230-233.
  • Wagener JF, Rao SV. Radial artery occlusion after transradial approach to cardiac catheterization. Curr Atheroscler Rep 2015;17(3):489.
  • Kristic I, Lukenda J. Radial artery spasm during transradial coronary procedures. J Invasive Cardiol 2011;23(12):527-531.
  • Lo TS, Nolan J, Fountzopoulos E, et al. Radial artery anomaly and its influence on transradial coronary procedural outcome. Heart 2009;95(5):410-415.
  • Curtis E, Fernandez R, Lee A. The effect of vasodilatory medications on radial artery spasm in patients undergoing transradial coronary artery procedures: a systematic review. JBI Database System Rev Implement Rep 2017;15(7):1952-1967.
  • Abdelazeem B, Abuelazm MT, Swed S, et al. The efficacy of nitroglycerin to prevent radial artery spasm and occlusion during and after transradial catheterization: A systematic review and meta-analysis of randomized controlled trials. Clin Cardiol 2022;45(12):1171-1183.
  • De Luca G, Schaffer A, Wirianta J, Suryapranata H. Comprehensive meta-analysis of radial vs femoral approach in primary angioplasty for STEMI. Int J Cardiol 2013;168(3):2070-2081.
  • Kwok CS, Rashid M, Fraser D, Nolan J, Mamas M. Intra-arterial vasodilators to prevent radial artery spasm: a systematic review and pooled analysis of clinical studies. Cardiovasc Revasc Med 2015;16(8):484-490.
  • Brownlee,M. Biochemistry and molecular cell biology of diabetic complications. Nature 2001;414(6865):813-820.
  • Kofler S, Nickel T, Weis M. Role of cytokines in cardiovascular diseases: a focus on endothelial responses to inflammation. Clin Sci (Lond) 2005;108(3):205-213.
There are 13 citations in total.

Details

Primary Language Turkish
Subjects Cardiology
Journal Section Research Articles
Authors

Yücel Kanal 0000-0003-0934-0266

Hatice Eftal Şeyda Kanal 0000-0002-0311-050X

Publication Date October 10, 2023
Submission Date July 30, 2023
Acceptance Date September 19, 2023
Published in Issue Year 2023 Volume: 5 Issue: 3

Cite

AMA Kanal Y, Kanal HEŞ. Radial arter yoluyla yapılan elektif koroner anjografi sırasında radial sheat içerisinden yapılan nitrogliserin dozu ile radial arter spazmının ilişkisi. Hitit Medical Journal. October 2023;5(3):216-220. doi:10.52827/hititmedj.1334133