Author + information
- Andy Wai-Kwong Chan1
Radial artery spasm (RAS) is one of the main reasons causing failure and/or complication of trans-radial intervention (TRI). Causes of spasm include anxious/sensitive patient, small radial artery size, and frequent catheter passage, especially guiding catheter with relative blunt tip. RAS usually resolves with intra-arterial vasodilator, sedation and/or analgesics but sometimes persists despite all kinds of treatment. Since brachial artery spasm rarely occurs and initial entry of hydrophilic radial sheath with the assistance of the tapered dilator is usually easy, use of 25 cm long radial sheath up to distal brachial artery should avoid RAS.
All coronary procedures done by the author at a single cardiac catheterization laboratory (CCL) from June 2013 to November 2016 were entered into the data set. All procedures were done by trans-radial route (except 2 transfemoral because of a very weak radial pulse) using 6F 25cm long hydrophilic radial sheath (St Jude Engage TR sheath or Terumo M Coat Radial Sheath). The patients' demographics including age and sex, the body weight, the nature of procedure, the nature and dosage of drugs used, the presence of RAS, the vessels tackled, success/failure of procedure, in-hospital and early (within 1 week of procedure) vascular complications and major adverse cardiac event were all recorded.
There was a total of 332 coronary procedures done by the author at that CCL during that period. There was 286 coronary angiogram (CA) proceeding to percutaneous coronary intervention (PCI), 28 CA with intravascular ultrasound but not PCI, and 18 CA only. There were 225 males and 107 females, with an average age of 63.6 years old (35–93), and body weight of 67.8 kg (40–121). All CA or/and PCI were successfully done trans-radially using the 6F 25 cm long hydrophilic radial sheath. No switch over to transfemoral route was needed. No clinically significant RAS was noted. No injection of vasodilator/ sedation/ analgesics was needed for relief of RAS. At the end of the procedures, all the sheaths were successfully removed without difficulty or complication. All patients were discharged the next morning. No major adverse cardiac event or vascular complication was noted during hospitalization and clinic follow-up within a week after the procedure.
TRI using 25 cm long hydrophilic radial sheath (St Jude Engage TR sheath or Terumo M Coat Radial Sheath) up to distal brachial artery seemed to eliminate the problem of clinically significant radial artery spasm without the use of intra-arterial vasodilators, sedative and/ or analgesics. The use of this long hydrophilic radial sheath also appeared safe without any vascular complication. There was no problem in the removal of the sheath after the procedure. A larger scale, prospective randomized trial of long versus ordinary radial sheath in TRI may be warranted.