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RANDOMIZED STUDY COMPARING STRATEGIES TO COMBAT RADIAL ARTERY SPASM: THE COMBAT SPASM TRIAL
87 JACC April 5, 2016 Volume 67, Issue 13
ACC.i2 Interventional Cardiology RANDOMIZED STUDY COMPARING STRATEGIES TO COMBAT RADIAL ARTERY SPASM: THE COMBAT SPASM TRIAL Poster Contributions Poster Area, South Hall A1 Saturday, April 02, 2016, 10:00 a.m.-10:45 a.m. Session Title: ACC.i2 Interventional Cardiology: Vascular Access and Complications Abstract Category: 12. ACC.i2 Interventional Cardiology: Vascular Access and Complications Presentation Number: 1106-187 Authors: Carlos A. Collet, Juan Corral, Nestor Cruz, Fernando Bosch, Luis Barrios, Miguel Mejia, Juan Munoz, Eastern Plains Cardiovascular Center, Villavicencio, Colombia, Cardiovascular Research Center Colombia, Villavicencio, Colombia
Background: Transradial approach for coronary interventions is associated with fewer vascular complications and improved outcomes especially in the acute patient setting. However, radial artery spasm (RAS) is a major limitation and the main cause of access site crossover. There is still controversy about the efficacy of intra-arterial administration of antispastic agents to reduce RAS and access site crossover. Therefore our objective was to determine the effectiveness of a novel strategy to treat RAS and avoid access site crossover.
Methods: Randomized, single center, open label trial comparing a novel strategy of pressure-mediated dilatation vs. intra-arterial administration of a combination of nitroglycerin 100 mcg plus verapamil 2,5 mg. We included patients with clinically significant and angiographic confirmation of RAS, and performed radial artery angiography before and after treatment. The primary objective was acute radial artery gain measure with quantitative radial artery angiography. The secondary safety objective was the rate of radial artery occlusion assess by Doppler at follow-up. Results: Twenty patients were included, overall the mean age was 65,1 years, 29% were females and 17% were diabetics with no differences between the groups. Pre-treatment minimal luminal diameter (MLD) and radial artery stenosis were 1.1 mm and 39% mm in the pressure-mediated group and 0.94 mm 44% in the nitroglycerin-verapamil group (p=NS). The primary end-point of radial artery gain was significantly greater in the pressure-mediated dilatation group (0.8 mm vs. 0.03 mm, p<0.001) and post-treatment percent diameter stenosis was significantly lower in the pressure-mediated dilatation group (9.9% vs. 40.5%, p=0.03). Blood pressure significantly change in the nitroglycerin plus verapamil compared to pressure-mediated dilatation group (ΔBP -31.6 vs -3.8 mmHg, p<0.001). There was one case of radial artery occlusion in the pressure-mediated dilatation group at follow-up.
Conclusions: This novel technique of pressure-mediated radial artery dilatation is superior to a pharmacologic antispastic approach for the treatment of RAS, with no concerns in hemodynamic parameters.
ACC.i2 Interventional Cardiology RANDOMIZED STUDY COMPARING STRATEGIES TO COMBAT RADIAL ARTERY SPASM: THE COMBAT SPASM TRIAL Poster Contributions Poster Area, South Hall A1 Saturday, April 02, 2016, 10:00 a.m.-10:45 a.m. Session Title: ACC.i2 Interventional Cardiology: Vascular Access and Complications Abstract Category: 12. ACC.i2 Interventional Cardiology: Vascular Access and Complications Presentation Number: 1106-187 Authors: Carlos A. Collet, Juan Corral, Nestor Cruz, Fernando Bosch, Luis Barrios, Miguel Mejia, Juan Munoz, Eastern Plains Cardiovascular Center, Villavicencio, Colombia, Cardiovascular Research Center Colombia, Villavicencio, Colombia
Background: Transradial approach for coronary interventions is associated with fewer vascular complications and improved outcomes especially in the acute patient setting. However, radial artery spasm (RAS) is a major limitation and the main cause of access site crossover. There is still controversy about the efficacy of intra-arterial administration of antispastic agents to reduce RAS and access site crossover. Therefore our objective was to determine the effectiveness of a novel strategy to treat RAS and avoid access site crossover.
Methods: Randomized, single center, open label trial comparing a novel strategy of pressure-mediated dilatation vs. intra-arterial administration of a combination of nitroglycerin 100 mcg plus verapamil 2,5 mg. We included patients with clinically significant and angiographic confirmation of RAS, and performed radial artery angiography before and after treatment. The primary objective was acute radial artery gain measure with quantitative radial artery angiography. The secondary safety objective was the rate of radial artery occlusion assess by Doppler at follow-up. Results: Twenty patients were included, overall the mean age was 65,1 years, 29% were females and 17% were diabetics with no differences between the groups. Pre-treatment minimal luminal diameter (MLD) and radial artery stenosis were 1.1 mm and 39% mm in the pressure-mediated group and 0.94 mm 44% in the nitroglycerin-verapamil group (p=NS). The primary end-point of radial artery gain was significantly greater in the pressure-mediated dilatation group (0.8 mm vs. 0.03 mm, p<0.001) and post-treatment percent diameter stenosis was significantly lower in the pressure-mediated dilatation group (9.9% vs. 40.5%, p=0.03). Blood pressure significantly change in the nitroglycerin plus verapamil compared to pressure-mediated dilatation group (ΔBP -31.6 vs -3.8 mmHg, p<0.001). There was one case of radial artery occlusion in the pressure-mediated dilatation group at follow-up.
Conclusions: This novel technique of pressure-mediated radial artery dilatation is superior to a pharmacologic antispastic approach for the treatment of RAS, with no concerns in hemodynamic parameters.