Abstract
One of the major disadvantages of the transradial approach during cardiac interventions is radial artery spasm. Severe vasospasm of the radial artery causing catheter entrapment is less frequently encountered and its management has rarely been reported. Herein, a 72-year-old female patient who was scheduled for an elective left heart catheterization due to exertional angina pectoris is reported. During transradial diagnostic coronary angiography, catheter entrapment occurred due to severe vasospasm of the radial artery. Reversal of severe vasospasm and release of entrapped catheter was not possible until low dose sedation with intravenous midazolam was given. This case report demonstrates that low dose sedation with intravenous midazolam could be used effectively to reverse resistant vasopasm of the radial artery during transradial interventions
References
- Kiemeneij F, Vajifdar BU, Eccleshall SC, Laarman G, Slagboom T, van der Wieken R. Evaluation of a spasmolytic cocktail to prevent radial artery spasm during coronary procedures. Catheter Cardiovasc Interv 2003;58:281-4.
- Ho HH, Jafary FH, Ong PJ. Radial artery spasm during transradial cardiac catheterization and percutaneous coronary intervention: incidence, predisposing factors, prevention, and management. Cardiovasc Revasc Med 2012;13:193-5.
- Jolly SS, Amlani S, Hamon M, Yusuf S, Mehta SR. Radial versus femoral access for coronary angiography or intervention and the impact on major bleeding and ischemic events: a systematic review and meta- analysis of randomized trials. Am Heart J 2009;157:132-40.
- He GW, Yang CQ. Characteristics of adrenoceptors in the human radial artery: clinical implications. J Thorac Cardiovasc Surg 1998;115:1136-41.
- Varenne O, Jégou A, Cohen R, Empana JP, Salengro E, Ohanessian A, et al. Prevention of arterial spasm during percutaneous coronary interventions through radial artery: the SPASM study. Catheter Cardiovasc Interv 2006;68:231-5.
- Rathore S, Stables RH, Pauriah M, Hakeem A, Mills JD, Palmer ND, et al. Impact of length and hydrophilic coating of the introducer sheath on radial artery spasm during transradial coronary intervention: a randomized study. JACC Cardiovasc Interv 2010;3:475-83.
- Deftereos S, Giannopoulos G, Raisakis K, Hahalis G, Kaoukis A, Kossyvakis C, et al. Moderate procedural sedation and opioid analgesia during transradial coronary interventions to prevent spasm: a prospective randomized study. JACC Cardiovasc Interv 2013;6:267-73.
- Colussi GL, Di Fabio A, Catena C, Chiuch A, Sechi LA. Involvement of endothelium-dependent and -independent mechanisms in midazolam-induced vasodilation. Hypertens Res 2011;34:929-34.
- Borges AA, Gomes OM. Effects of midazolam on the contraction and relaxation of segments of thoracic aorta stripped of endothelium and stimulated by adrenaline-experimental study in rabbits. Mol Cell Biochem 2003:246;13-7.
- Kallivalappil SC, Pullani AJ, Abraham B, Kumar MK, Ashraf SM. Entrapment of a transradial angiogram catheter because of severe vasospasm. J Cardiothorac Vasc Anesth 2008;22:428-30.
- Pullakhandam NS, Yang ZJ, Thomas S, Wasenko J. Unusual complication of transradial catheterization. Anesth Analg 2006;103:794-5.
Transradyal Anjiogram Kateter Tuzaklanmasına Neden Olan Şİddetlİ Vasospazmİn Düşük Doz Sedasyon İle Çözülmesi
Abstract
Kardiyak girişimlerde transradyal yaklaşımın önemli dezavantajlarından biri radyal arter spazmıdır. Kateter tuzaklanmasına neden olan şiddetli radyal arter vazospazmı daha az sıklıkla görülür ve tedavisi nadiren bildirilmiştir. Yazımızda efor anginası nedeniyle elektif sol kalp kateterizasyonu planlanan 72-yaşında bir kadın hasta bildirildi. Transradyal tanısal koroner anjiyografi esnasında radyal arterin şiddetli vazospazmına bağlı kateter tuzaklanması gelişti. Intravenöz midazolam ile düşük doz sedasyon uygulanana kadar şiddetli vasospazmın gerilemesi ve kateter tuzaklanmasının çözülmesi mümkün olmadı. Bu vaka intravenöz midazolam ile düşük doz sedasyonun transradyal girişimler esnasında oluşan dirençli radyal arter vasospazmının tedavisinde etkili olabileceğini göstermiştir.
References
- Kiemeneij F, Vajifdar BU, Eccleshall SC, Laarman G, Slagboom T, van der Wieken R. Evaluation of a spasmolytic cocktail to prevent radial artery spasm during coronary procedures. Catheter Cardiovasc Interv 2003;58:281-4.
- Ho HH, Jafary FH, Ong PJ. Radial artery spasm during transradial cardiac catheterization and percutaneous coronary intervention: incidence, predisposing factors, prevention, and management. Cardiovasc Revasc Med 2012;13:193-5.
- Jolly SS, Amlani S, Hamon M, Yusuf S, Mehta SR. Radial versus femoral access for coronary angiography or intervention and the impact on major bleeding and ischemic events: a systematic review and meta- analysis of randomized trials. Am Heart J 2009;157:132-40.
- He GW, Yang CQ. Characteristics of adrenoceptors in the human radial artery: clinical implications. J Thorac Cardiovasc Surg 1998;115:1136-41.
- Varenne O, Jégou A, Cohen R, Empana JP, Salengro E, Ohanessian A, et al. Prevention of arterial spasm during percutaneous coronary interventions through radial artery: the SPASM study. Catheter Cardiovasc Interv 2006;68:231-5.
- Rathore S, Stables RH, Pauriah M, Hakeem A, Mills JD, Palmer ND, et al. Impact of length and hydrophilic coating of the introducer sheath on radial artery spasm during transradial coronary intervention: a randomized study. JACC Cardiovasc Interv 2010;3:475-83.
- Deftereos S, Giannopoulos G, Raisakis K, Hahalis G, Kaoukis A, Kossyvakis C, et al. Moderate procedural sedation and opioid analgesia during transradial coronary interventions to prevent spasm: a prospective randomized study. JACC Cardiovasc Interv 2013;6:267-73.
- Colussi GL, Di Fabio A, Catena C, Chiuch A, Sechi LA. Involvement of endothelium-dependent and -independent mechanisms in midazolam-induced vasodilation. Hypertens Res 2011;34:929-34.
- Borges AA, Gomes OM. Effects of midazolam on the contraction and relaxation of segments of thoracic aorta stripped of endothelium and stimulated by adrenaline-experimental study in rabbits. Mol Cell Biochem 2003:246;13-7.
- Kallivalappil SC, Pullani AJ, Abraham B, Kumar MK, Ashraf SM. Entrapment of a transradial angiogram catheter because of severe vasospasm. J Cardiothorac Vasc Anesth 2008;22:428-30.
- Pullakhandam NS, Yang ZJ, Thomas S, Wasenko J. Unusual complication of transradial catheterization. Anesth Analg 2006;103:794-5.
Details
| Primary Language | English |
|---|---|
| Journal Section | Case Report |
| Authors | |
| Publication Date | June 1, 2015 |
| Published in Issue | Year 2015Issue: 2 |