Читать книгу Interventional Cardiology - Группа авторов - Страница 83

The radial artery is a muscular vessel with abundant α‐adreno‐receptors located in the adventitia. The mean size of the proximal radial artery is 2.55mm ± 0.39 and is marginally bigger than the distal radial artery in the anatomical snuffbox (2.34mm ± 0.36, difference 0.2 ± 0.16mm; p < 0.001) (33). With limited vessel clearance, catheter advancement can induce local trauma with resultant vasospasm and arm pain. Any further catheter manipulation without remedial action will exacerbate the problem and lead to access‐site crossover. Radial artery spasm (Figure 3.1d) occurs in roughly 15% of procedures with several predictive risk factors including female sex, higher radial artery takeoff, smaller artery diameter, larger cathetersize, increased number of punctures and pain response during cannulation [34].

With increased operator experience and the development of hydrophilic catheters, the incidence of vasospasm has reduced [35]. Preventative measures that vasodilate the artery and limit arm pain can be employed to lower the risk of spasm. Intra‐arterial lignocaine injection can induce vasospasm and should be avoided [36]. Administration of a “radial cocktail” of anti‐spasmodic drugs via the arterial sheath should be routinely administered [37]. Both glyceryl trinitrate (0.1–0.4 mg) and verapamil (2.5–5 mg) have a strong evidence base in preventing spasm without significant hemodynamic consequences [38]. We prefer heparin (2000–5000 IU) administration into the aorta rather than via the radial sheath given that it is painful and potentially mediates spasm while simplifying a TFA approach should this be necessary. Adequate sedation/analgesia also play an important role in reducing failure of TRA [39].