Sural Sefa, Döğen Mehmet Ercüment, Duzel Baris, Karaca Ozkan, Brilakis Emmanouil S, Gorgulu Sevket
Department of Cardiology, Faculty of Medicine, Istinye University, Sariyer, Istanbul, Turkey.
Department of Radiology, Faculty of Medicine, Istinye University, Sariyer, Istanbul, Turkey.
Catheter Cardiovasc Interv. 2025 Aug;106(2):1247-1254. doi: 10.1002/ccd.31675. Epub 2025 Jun 8.
Radial artery spasm (RAS) is the most common complication of transradial cardiac catheterization (TRA), potentially leading to procedural failure, crossover to an alternative access site, and increased patient discomfort. Preventing RAS is critical for procedural success and safety.
To evaluate whether pre-procedural administration of oral verapamil reduces the incidence of clinical and ultrasound-defined radial artery spasm in patients undergoing TRA.
We conducted a prospective, randomized clinical trial (NCT06447688) comparing 120 mg of oral verapamil with placebo administered 2 h before the procedure. The primary endpoints were the incidence of clinical RAS and ultrasound-based radial artery area change. Secondary endpoints included procedural success, contrast volume, dose area product, and fluoroscopy time.
Among 231 screened patients, 150 were randomized (75 verapamil, 75 placebo). The verapamil group showed significantly lower rates of clinical RAS (4% vs. 30.7%, p < 0.001) and ultrasonographically defined RAS (10.7% vs. 48%, p < 0.001). In addition, reductions in proximal and middle radial artery area were significantly smaller in the verapamil group (p < 0.001 for both). No significant differences were observed in procedural success, fluoroscopy time, radiation dose, or contrast volume.
Oral verapamil administered 2 h before TRA significantly reduces the rate of radial artery spasm and vasoconstriction. This strategy may improve patient comfort and procedural outcomes without increasing adverse effects.
桡动脉痉挛（RAS）是经桡动脉心脏导管插入术（TRA）最常见的并发症，可能导致手术失败、改用其他入路部位以及患者不适增加。预防RAS对于手术的成功和安全至关重要。
评估术前口服维拉帕米是否能降低接受TRA患者临床及超声定义的桡动脉痉挛发生率。
我们进行了一项前瞻性随机临床试验（NCT06447688），比较术前2小时给予120mg口服维拉帕米与安慰剂的效果。主要终点为临床RAS发生率及基于超声的桡动脉面积变化。次要终点包括手术成功率、造影剂用量、剂量面积乘积及透视时间。
在231例筛查患者中，150例被随机分组（75例维拉帕米组，75例安慰剂组）。维拉帕米组临床RAS发生率（4%对30.7%，p<0.001）及超声定义的RAS发生率（10.7%对48%，p<0.001）显著更低。此外，维拉帕米组桡动脉近端和中段面积的减小也显著更小（两者p均<0.001）。手术成功率、透视时间、辐射剂量或造影剂用量方面未观察到显著差异。
TRA术前2小时口服维拉帕米可显著降低桡动脉痉挛和血管收缩发生率。该策略可改善患者舒适度及手术结局，且不增加不良反应。
