Effect of transdermally applied nitroglycerin or lidocaine before transradial coronary angiography on procedure success and complications

Abstract

Objective: We investigated the effect of transdermal nitroglycerin or lidocaine application on puncture time, number, and complications in patients who underwent transradial coronary angiography.

Methods: Patients with topical saline applied to the radial artery before the procedure were designated as Group 1 (n=59), those with topical nitrate were designated as Group 2 (n=43), and those with topical lidocaine were designated as Group 3 (n=40). The groups' puncture time, number, and complication rates were compared.

Results: While our average puncture time was 142±122 seconds in all patients, this time was measured as 171±131 seconds in Group 1, 88±48 seconds in Group 2, and 157±146 seconds in Group 3 (P=0.021). During the procedure, radial artery spasm was observed in 15.2% of patients in Group 1, 6.9% in Group 2, and 12.5% in Group 3 (P=0.043). Radial artery occlusion was seen in 8% of patients in Group 1, and 2.5% in Group 3, while it was not observed at all in the nitrate-applied group (P=0.041).

Conclusion: The topical application of nitroglycerin before transradial angiography is a feasible strategy to reduce radial puncture time and number, facilitate trans-radial catheterization, and decrease the incidence of radial artery spasm and occlusion.

Keywords

• Transradial coronary angiography
• transdermal
• nitroglycerin
• lidocaine
• spasm

References

1. 1. Dal Molin A, Faggiano F, Bertoncini F, et al. Bed rest for preventing complications after transfemoral cardiac catheterisation: a protocol of systematic review and network meta-analysis. Syst Rev. 2015;4:47. doi: 10.1186/s13643-015-0036-0.
2. 2. Neumann FJ, Sousa-Uva M, Ahlsson A, et al; ESC Scientific Document Group. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019;40(2):87-165. doi: 10.1093/eurheartj/ehy394.
3. 3. Ahsan MJ, Ahmad S, Latif A, et al. Transradial versus transfemoral approach for percutaneous coronary intervention in patients with ST-elevation myocardial infarction complicated by cardiogenic shock: a systematic review and meta-analysis. Eur Heart J Qual Care Clin Outcomes. 2022;8(6):640-650. doi: 10.1093/ehjqcco/qcac018.
4. 4. Morton J, Kern Paul Sorajja, Michael J. Lim 4th Edition. The Interventional Cardiac Catheterization Handbook. Philadelphia: Elsevier, 2018.
5. 5. Khan MZ, Patel K, Franklin S, Faruqi A, Ahmad W, Saeed J. Radial artery spasm: reviews and updates. Ir J Med Sci. 2020;189(4):1253-1258. doi: 10.1007/s11845-020-02203-9.
6. 6. Beyer AT, Ng R, Singh A, et al. Topical nitroglycerin and lidocaine to dilate the radial artery prior to transradial cardiac catheterization: a randomized, placebo-controlled, double-blind clinical trial: the PRE-DILATE Study. Int J Cardiol. 2013;168(3):2575-2578. doi: 10.1016/j.ijcard.2013.03.048.
7. 7. Roghani F, Shirani B, Hashemifard O. The effect of low dose versus standard dose of arterial heparin on vascular complications following transradial coronary angiography: Randomized controlled clinical trial. ARYA Atheroscler. 2016;12(1):10-17.
8. 8. Dharma S, Kedev S, Patel T, Kiemeneij F, Gilchrist IC. A novel approach to reduce radial artery occlusion after transradial catheterization: postprocedural/prehemostasis intra-arterial nitroglycerin. Catheter Cardiovasc Interv. 2015;85(5):818-825. doi: 10.1002/ccd.25661.

9. 9. da Silva RL, Dangas GD, de Andrade PB, et al. Effect of randomized prophylactic nitroglycerin on radial artery spasm during transradial catheterization: An analysis based on operator experience. Catheter Cardiovasc Interv. 2023 Feb;101(3):579-586. doi: 10.1002/ccd.30541.
10. 10. Coroleu S, Allín J, Migliaro G, Leiva G, Baglioni P, Nogués I. Use of subcutaneous nitroglycerin to facilitate transradial access in coronary procedures (NiSAR study). REC Interv Cardiol. 2021;3(1):26-32. doi: 10.24875/RECICE.M20000141.