Khan Zahid, Koh Tat
Acute Medicine, Mid and South Essex NHS Foundation Trust, Southend-on-Sea, GBR.
Cardiology, Bart's Heart Centre UK, London, GBR.
Cureus. 2025 Mar 6;17(3):e80161. doi: 10.7759/cureus.80161. eCollection 2025 Mar.
Over the past decade, there has been a significant increase in the use of the transradial approach in patients undergoing coronary angiography due to lower risk of complications and quicker recovery. Nevertheless, radial artery spasm remains a challenge, particularly in anxious men and women, and young female patients. Transradial access is associated with a significantly lower bleeding risk compared to transfemoral access. The radial artery is predisposed to significant spasms as it has a smaller caliber and is highly sensitive to mechanical and humoral stresses compared to femoral artery. We present the case of an 82-year-old male who was transferred from a district general hospital for coronary angiography and developed severe spasm in the right radial artery at the end of the procedure, resulting in radial artery sheath entrapment. We administered 600 microgram of intra-arterial nitrates, 2.5 mg intra-arterial verapamil, 3.5 mg midazolam, and 2.5 mg intravenous morphine with no effect on the spasm. Following this, we applied a blood pressure cuff and inflated it to 156 mmHg, which was 40 mmHg greater than his systolic blood pressure, for five minutes to occlude the brachial artery. This resulted in smooth muscle relaxation facilitating the removal of radial sheath without any adverse outcomes.
在过去十年中，由于并发症风险较低且恢复较快，经桡动脉途径在接受冠状动脉造影的患者中的使用显著增加。然而，桡动脉痉挛仍然是一个挑战，尤其是在焦虑的男性和女性以及年轻女性患者中。与经股动脉途径相比，经桡动脉途径的出血风险显著降低。桡动脉由于管径较小，与股动脉相比对机械和体液应激高度敏感，因此易发生严重痉挛。我们报告一例82岁男性患者，他从一家地区综合医院转来进行冠状动脉造影，在手术结束时右侧桡动脉发生严重痉挛，导致桡动脉鞘管嵌顿。我们给予了600微克动脉内硝酸盐、2.5毫克动脉内维拉帕米、3.5毫克咪达唑仑和2.5毫克静脉注射吗啡，但对痉挛均无效果。在此之后，我们应用了一个血压袖带并将其充气至156 mmHg，比他的收缩压高40 mmHg，持续五分钟以阻断肱动脉。这导致平滑肌松弛，便于顺利取出桡动脉鞘管，且未出现任何不良后果。
