Is it possible to do an angiography via radial artery without vasospasm?

A. Goldsmit, C. Sztejfman, F. Chiminela, et al. from Argentina & US.
Aims: We sought to evaluate Nalbufine Chloridrate (NC) safety and efficacy in preventing vasospasm during coronary angiography (CA), elective carotid angiography (ECA) and percutaneous coronary intervention (PCI) via the radial artery.
Methods and results: 500 consecutive patients scheduled to have CA, ECA and PCI via radial artery were enrolled in a prospective fashion. The same operator performed all procedures. Prior to initiation of each procedure, 3 mg of IV NC were given. 1 ml of Lidocaine 2% was utilised for local anesthesia. A 6 Fr Terumo radial introducer was used followed by 5000 U of un-fractionated heparin (UFH). Vasospasm was defined as trapping/difficulty to mobilise the catheter or local access site pain. Exclusion criteria were defined as patients with positive Allen test, arterio-venous (AV) fistula, cardiogenic shock, patients anticipating hemo-dyalisis, need for a 7Fr system or not palpable radial pulse. Patients were enrolled in a single center between January 2007 and October 2008. 78% were male, the mean age was 60 +/- 23, 82% of patients underwent elective CA or ECA and 18% of patients had PCI. Severe local pain was present only in 1.2% of patients, which resolved after 2mg IV of NC. 14% of patients referred only mild pain at the access site. None of the case experienced catheter trapping or manipulation difficulties. There was no evidence of local complications, defined as local hematomas > 5 cms, bleeding, pseudoaneurysms, AV fistulas, neuralgias, local ischemia or distal embolic events.
Conclusions: The utilisation IV NC is safe and efficacious to prevent vasospasm in trans radial intervention to perform CA, ECA and PCI. Only 1.2% of patients in our cohort had severe local pain or vasospasm.Coronary – Technique Transradial approach for percutaneous coronary intervention, euro PCR