Skip to main content

Clinical predictors and management for radial artery spasm: an Australian cross-sectional study

A Correction to this article was published on 17 February 2023

This article has been updated

Abstract

Introduction

The transradial approach for coronary artery catheterisation has increased in popularity compared to the transfemoral approach for patients undergoing percutaneous coronary interventions. However, radial artery spasm continues to be a major complication of the procedure. Current management strategies vary concerning radial artery spasm and there is limited evidence of practice in the Australian context.

Aim

To identify the predictors of radial artery spasm and the medications used for its prevention and management.

Methods

A descriptive cross-sectional study was carried out over a three-month period in two tertiary hospitals in NSW, Australia. A self-administered pre-procedural survey was completed by patients undergoing coronary artery catheterisation. This survey collected socio-demographic data and assessed anxiety using the Spielberger State-Trait Anxiety Inventory. Procedural data, including length of procedure, equipment used, occurrence of radial artery spasm, and medications given, were collected post-procedure by the interventionalist.

Results

Of the 169 participants, over half were male (59.8%) and aged 66 years or older (56.8%). Radial artery spasm was reported in 24 (14.2%) participants. Rates of spasm were significantly higher among females (66.6%, p = 0.004), those aged under 65 years (62.5%, p = 0.001) and those who reported a medical history of anxiety (33.3%, p = 0.0004). There were no significant differences in State and Trait anxiety scores among those who had RAS and those who did not. Logistic regression identified younger age as the only statistically significant predictor of RAS (OR 0.536; 95% CI 0.171–1.684; p = 0.005).

To prevent radial artery spasm most patients received midazolam (n = 158; 93.5%), nitrates (n = 133; 78.7%) and/or fentanyl (n = 124; 73.4%) prophylactically. Nitrates were the most frequently administered medication to treat radial artery spasm (78.7%).

Conclusion

This study highlights that there is a need to develop a clearer understanding of the predictors of RAS, as identifying patients at risk can ensure prophylactic measures are implemented. This study identified nitrates as the preferred vasodilator as a preventative measure along with the use of sedation.

Peer Review reports

Introduction

Percutaneous coronary angiography is used for the diagnosis and treatment of coronary artery disease. This procedure allows interventionalists to view the coronary arteries and identify blockages that may be reducing blood flow to the heart muscle. Percutaneous coronary interventions (PCI) involve the insertion of a stent in a blocked coronary artery to revascularise the heart muscle. Advances in PCI techniques have resulted in the increasing use of this treatment modality, thereby reducing the need for coronary artery bypass surgery [1]. This results in significant improvements in patient outcomes and a reduction in health and personal costs [1].

Historically, the femoral artery was the main access site for angiography [2]. However, with improved technologies, other access points have become feasible options, including the radial, distal radial and ulnar arteries [3]. Evidence from a systematic review of randomised control trials found that the transradial approach (TRA) was associated with a decrease in short-term net adverse clinical events, reduction in cardiac death [4, 5], lengths of stay, access site complications [6], bleeding, short term mortality and increased patient satisfaction [7]. Given the benefits, the European Society of Cardiology guidelines for the management of ACS now indicates that TRA should be used for most patients under most circumstances as the preferred route of access (Class 1 recommendation) [8].

Despite the benefits associated with TRA, international rates of uptake of the approach have varied and reportedly range from 16.1% in the United States [9] to 73% in Italy [10]. The variable uptake in rates has been associated with risks and complications associated with TRA, limited learning opportunities and a prolonged learning curve for interventionalists [8]. The risks and complications associated with TRA are multifactorial. Firstly, patients can be exposed to a significantly increased fluoroscopy time and so receive a larger radiation dose when compared to transfemoral procedures. This radiation dose can also be significantly increased depending on the complexity of the procedure [7, 11]. The main complication associated with TRA is radial artery spasm (RAS) [12], which has been reported to occur in some 30% of TRA procedures [13,14,15]. RAS is the sudden constriction and narrowing of the radial artery, leading to difficulty in the advancement of the catheter and potentially procedural failure [16]. Procedural failure requires cross-over to an alternate access site resulting in longer procedural time and increased risk of complications associated with the alternate access site [7, 15].

Various factors including patient demographics, the presence of cardiovascular risk factors, anatomy of the radial arteries and procedural factors have been reported to increase the risk of RAS [12, 17,18,19,20]. Patient demographics linked to higher rates of RAS include female gender, increased age, smaller height, and lower weight [12, 17, 18]. Cardiovascular risk factors identified to increase the occurrence of RAS include hypertension, smoking, and anxiety [17, 19, 20]. Additionally, procedural factors, such as more than one radial puncture attempt or insertion of a ≥ 7F sheath have also been reported to predict RAS [18]. Based on the various factors that increase the risk of RAS, a predictive score for RAS has been developed. This score includes body mass index (BMI), height, hypertension, current smoking status, and peripheral artery disease [17, 18, 21]. The predictive scores enable the implementation of strategies to prevent the occurrence of RAS. Despite the presence of this scoring algorithm, much of the data about RAS and TRA have been drawn from international research. Limited research has been undertaken in the Australian context to understand the predictors of RAS and any variations in practice between countries.

Various prevention strategies including medications and specialised procedural equipment have been advocated to reduce RAS. Medications used include vasodilators, calcium channel blockers, sedation and analgesia, or a cocktail of these medications [22,23,24]. While a systematic review found that vasodilatory medications reduce the occurrence of RAS, there is insufficient evidence to identify a superior medication, dose or combination [25]. Prevention strategies related to specialised equipment include the use of hydrophilic equipment, special 6-in-5F sheaths, keeping catheter exchanges to a minimum and avoiding cold intra-arterial injections [26]. These strategies are designed to reduce friction and stimulation of the arterial wall subsequently reducing the occurrence of spasm. To date, however, there has been limited exploration of the practices around RAS prophylaxis in the Australian context.

This study is part of a larger study, the AnxieTy, health Literacy and radial Artery Spasm (ATLAS) study, which aimed to identify the association of anxiety and health literacy concerning RAS during transradial coronary angiography.Given the limited evidence in the Australian context about RAS, this study sought to identify predictors, prevention and management of RAS and explore practices concerning TRA for coronary artery catheterisation in Australia. Developing a baseline understanding of practices is important to inform practitioner learning needs specific to each environment. Promoting evidence-based best practice has clear benefits in improving outcomes and ensuring responsible use of finite health resources.

Methods

This descriptive cross-sectional study was undertaken over a three month period in the cardiac catheterisation laboratories of two metropolitan tertiary hospitals in New South Wales, Australia. At the time of the study both cardiac catheterisation laboratories carried out over 35 radial catheterisation procedures a week. Data collection combined a self-administered survey completed by patients before their procedure and a data sheet completed by the interventionalist following the procedure.

Participants and recruitment

Participants were outpatients referred for coronary angiography with or without PCI. People were included in the study if they were aged over 18 years and able to provide written consent. Exclusion criteria were people with acute coronary syndrome, hospital inpatients, or those unable to speak or read sufficient English to consent or complete the survey. People with acute coronary syndrome and hospital inpatients were excluded as these characteristics would increase anxiety levels and thus create a bias towards RAS. Patients were invited by a research assistant to participate in the study once they had been admitted and prepared for their procedure. Using a margin of error of 3%, a 95% confidence level, and 300 as the population size, a required sample size of 169 was determined.

Data collection tools

A survey tool was developed by the researchers based on current evidence on RAS predictors and feedback from interventionalists. A hard copy survey was given to participants to complete before their procedure by the registered nurse after consent was obtained. The survey tool consisted of two sections, the first section explored socio-demographic data, including age, gender, marital status, education, medical history (including history of anxiety) and current medications. The second section measured anxiety using the 40-item Spielberger State-Trait Anxiety Inventory (STAI) [27], a tool used widely to evaluate anxiety [28,29,30,31]. The STAI combines state anxiety (20 items), which is anxiety occurring in a current situation, and trait anxiety (20 items), which is anxiety that occurs on most days. Items are scored on a 4-point Likert scale from 1 ‘Not at all’ to 4 ‘Very much so’. A total score is calculated for each scale. A state anxiety score of 36 and over was considered high state anxiety, while a trait anxiety score of 35 and over was considered high trait anxiety [32]. The internal consistency coefficients of the STAI range from 0.86 to 0.95 and test–retest reliability coefficients range from 0.65 to 0.75 [32].

Post-procedural data were collected using a data sheet completed by the interventionalists. The data sheets were matched to patient surveys using patient codes. Data collected post-procedure included medications and equipment used during the procedure, the occurrence of RAS and other complications and the time taken for the procedure. The presence of RAS was documented if there was restricted movement of the catheter and forearm pain [25] and spasm was confirmed with radial artery imaging.

Ethics

Ethical approval was obtained from the Hospital Human Research Ethics Committee (Approval No 16/234). Participants were informed that all data would be de-identified and aggregated, and that non-participation would not affect their care. Written consent was gained from patients before completing the survey. Confidentiality was maintained using numerical unique identifiers. The list of numbers and patient names were kept separately by the lead researcher.

Analysis

All hard copy data were entered into SPSS V 25 [33] for analysis by an independent research assistant and data was cross checked by two members of the research team. Continuous data were presented as means/standard deviation and categorical data as frequencies and percentages. Age was dichotomised into less than 65 years and 66 years and over. Univariate analysis was used to identify associations between demographic and clinical factors and the occurrence of RAS. Factors that were significant in univariate analysis were then subject to logistic regression using the Hosmer–Lemeshow test [34]. The Hosmer–Lemeshow test correctly fitted the data (χ2 = 3.344; sig. = 0.911) indicating that the overall model fit is good. A p > 0.05 was considered statistically significant.

Results

Patient characteristics

One hundred and ninety-five participants were recruited during the study period, however, data on RAS occurrence were missing for 26 participants (13.3%), leaving 169 (86.7%) participants for inclusion in the analysis. While the registered nurses were asked to collect data on the eligible participants who declined to participate, these data were not always collected due to time pressures and administrative workload. Therefore, it is not possible to calculate a response rate.

The majority of participants were male (n = 101; 59.8%), aged 66 years or over (n = 96; 58.2%), and were non-smokers (n = 149; 90.4%). Reported previously-diagnosed conditions included high cholesterol (n = 77; 45.6%), hypertension (n = 73; 43.2%), heart disease (n = 44; 26%) and anxiety (n = 18; 10.7%) (Table 1). Overall interventionalists reported administering heparin (n = 158; 93.5%), vasodilators (n = 134; 79.3%), and sedatives (n = 155; 91.7%) to participants.

Table 1 Patient characteristics and univariate analysis

The mean state and trait anxiety scores were 36.47 (SD = 11.59) and 35.37 (SD = 9.83) respectively. Over half (n = 90; 53.3%) of the participants were classified as having high state anxiety, while less than half (n = 82; 48.5%) were classified as having high trait anxiety. Cronbach’s alpha was 0.889 for state anxiety and 0.894 for trait anxiety, demonstrating high reliability.

Procedural characteristics

Procedures were performed by twelve interventionalists and eleven advanced trainees. Most (n = 114; 69.1%) procedures were carried out by advanced trainees, however, 22 (13.3%) procedures were carried out by interventionalists and 21 (12.7%) procedures were carried out by both the advanced trainee and interventionalists.

Just over three-quarters of participants had a diagnostic angiogram (n = 120; 77.5%) (Table 1). Two (4.1%) participants had the procedure through the left radial artery, while the remainder were through the right radial artery (n = 162; 95.9%). In most procedures (n = 155; 91.7%) a 6-French sheath was used, while 4.7% (n = 8) had a 5-French sheath, the remaining were not recorded. Two or fewer catheters were used in 101 cases (61.9%) and while over a third of procedures (n = 62; 38.0%) had three or more catheters, the remaining six participants did not have the number of catheters recorded. The mean duration of the procedures was 35.5 min (SD 22.3 min).

Adverse events

Complications were experienced by 32 (18.9%) participants. These were RAS (n = 24; 14.2%); haematoma (n = 4; 2.4%), artery dissection (n = 1; 0.6%), infection (n = 1; 0.6%), pseudo-aneurysm (n = 1; 0.6%) and brachial perforation (n = 1; 0.6%). Rates of RAS were not significantly different between procedures carried out by a trainee alone (n = 11; 10.5%) compared to a consultant alone (n = 3; 13.6%). Crossover to the femoral artery during the procedure was required in 8 (4.7%) participants in total, five (62.5%) of these were because of RAS.

Predictors of RAS

Univariate analysis demonstrated a significantly higher incidence of RAS in participants aged under 65 years compared to those over 65 years (p = 0.001), those with a medical history of anxiety (p = 0.0004), female participants (p = 0.004) and those with an increased length of procedure time (p = 0.017). Multiple logistic regression identified younger age as a statistically significant predictor of RAS (OR 0.917; 95% CI 0.867–0.970; p = 0.003) (Table 2).

Table 2 Multivariate logistic regression analysis

Prophylactic medications for RAS

To prevent RAS, most patients received midazolam (n = 153; 90.5%), nitrates (n = 133; 78.7%) and/or fentanyl (n = 124; 73.4%) prophylactically. Only 19 participants (11.5%) received a single medication. Over half (n = 108; 65.5%) of participants received a combination of nitroglycerin, fentanyl and midazolam, while combinations of two medications were administered to 35 (21.2%) participants. Five participants (3%) received no medications before the procedure. There was no statistical significance in relation to RAS and medications used (p > 0.05).

Medications to treat RAS

Of the 24 participants who experienced RAS, 9 (37.5%) participants were administered nitrates to resolve the spasm, while 6 participants (25%) received additional midazolam, 5 (20.8%) participants received no treatment, and 4 participants (16.7%) received fentanyl.

Discussion

The TRA is becoming increasingly popular in coronary angiography, however, RAS continues to be a major complication of the procedure. Given the limited research in the Australian context assessing the predictors, prevention, management and prevalence of RAS, this study provides new insight into current practice in the Australian context. The prevalence of RAS seen in this study (14.2%), is consistent with international rates of RAS reported in the literature [14]. While several predictive factors are congruent with some findings reported internationally, there remains a lack of consensus between studies. This demonstrates the need for ongoing monitoring of RAS prevalence and predictors to promote a shared understanding of factors that increase the risk of RAS.

This study highlighted an association between age and RAS, with RAS occurring more frequently in younger patients. This is consistent with Trilla, Freixa [16] who found that patients who experienced RAS were generally younger. The lower incidence of RAS in older adults may be due to the processes of muscular denervation and endothelial dysfunction that have been associated with aging [16]. However, as other studies have identified older age as a predictor of RAS [17], further research is required to confirm the direction of this association.

This study found a relationship between those who had a self-reported medical history of anxiety and RAS, although did not find an association between RAS and preprocedural anxiety. This is in contrast with previous studies that have found a statistically-significant correlation between RAS and state anxiety [19, 20]. This indicates that those with prolonged levels of anxiety may be more susceptible to RAS compared to those who have a sudden spike in anxiety due to the impending procedure.

Consistent with other studies [12, 17, 18], this investigation found that the female gender was a predictor of RAS. Mong, Duggan [35] identify that the radial arteries of females are more sensitive to vasoconstrictors, while being less sensitive to vasodilators when compared to males. Additionally, females have smaller radial arteries, impacting the radial artery to sheath ratio, which increases the risk of RAS [17]. Some operators have a preference for starting with smaller-bore catheters for females because of these factors.

In this study, nitroglycerin was the most common vasodilator used prophylactically while midazolam was the most common sedative used to reduce RAS. The preference for these drugs is inconsistent with previous international studies, which have demonstrated a preference for either verapamil (9) or a cocktail of verapamil and nitroglycerin(21).. In this study, verapamil was only administered to one patient which is inconsistent with international practice. This could be due to the availability of the drug or patient contraindications for the use of verapamil. Best practice documents encourage the use of vasodilatory medications to reduce the incidence of RAS, while acknowledging the choice of medication is up to the operator [8, 13, 14]. Despite the differences in medication choice, the similar prevalence of RAS demonstrates that it is unlikely that the variation in drug administration impacted care.

The variation in dosages of prophylactic medications seen in this study is consistent with the literature [25]. In this study, no single vasodilatory medication was administered to over 14% of patients, indicating the wide variability in operator preferences. Both Hamon, Pristipino [13] and Mason, Shah [8] support the use of pre-procedural sedation to reduce the risk of RAS, noting that decreased discomfort and anxiety may assist in reducing the stimulation of neural pathways and arterial vasoconstriction. In this study, greater than 90% of patients received midazolam and/or fentanyl, a typical sedation cocktail administered before the procedure. However, the inconsistecies in prophylactic medications highlight the need for further work to ensure that best practice is implemented in the clinical setting.

This study found nitroglycerin to be the preferred medication to relieve RAS once it occurred followed by midazolam. Current evidence based guidelines identify additional spasmolytic therapy and analgesic administration when spasm occurs [14]. Spasmolytics include calcium channel blockers, such as verapamil, while suggested analgesics include midazolam, morphine or fentanyl. Although nitroglycerin does not fall under the category as a spasmolytic, it does have a vasodilating impact on the artery resulting in reports of sublingual or intra-arterial nitroglycerin as options to resolve RAS [36]. The use of intra-arterial nitroglycerin is common for other reasons apart from RAS in coronary procedures, so familiarity with this medication and its effects may be a reason this is most commonly used to relieve RAS.

Strengths and limitations

The major strength of this study was that it was undertaken at two different sites and included a sizeable number of clinicians undertaking the procedure to reduce the impact of personal preference. Additionally, the combination of patient and procedure data broadened the dataset. Using a validated instrument to measure patient anxiety ensured reliable and valid measurement.

Despite these strengths, there are several limitations. This study focused on procedural data, as a result some variables that may impact on the outcomes were not included (e.g. nutritional status, body mass index). Further research on the impact of these factors iswarranted. Although data were collected across three months, the sample size is modest. Due to factors beyond our control data about those who were excluded or did not consent was not always collected. The exclusion of people who did not have sufficient English language to consent or complete the survey restricts the cross-cultural generalisability of the study. Previous patient experience with angiography or associated procedures, that could impact on anxiety levels, was not evaluated. Additionally, medical history of anxiety was self-reported and therefore some participants may not have disclosed their medical history accurately.

Conclusion

Australian rates of RAS are consistent with those reported internationally. While this study demonstrated predictors for RAS to be younger age, females and medical history of anxiety, findings across the literature are not consistent. While the medication regimes used prophylactically in this study showed some variation from those reported internationally, they did not lead to significant differences in RAS prevalence. These international differences highlight the need for ongoing evaluation of large-scale procedural data internationally to achieve clarity around predictive factors and best practice. By understanding these data clinicians will be better able to screen patients before their procedure and reduce the prevalence of RAS.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Change history

References

  1. Bhatt DLJJ. Percutaneous coronary intervention in 2018. J Am Med Assoc. 2018;319(20):2127–8.

    Article  Google Scholar 

  2. Bianchi R, D’Acierno L, Crisci M, Tartaglione D, Cappelli Bigazzi M, Canonico M, et al. From femoral to radial approach in coronary intervention: review of the literature and 6 years single-center experience. Angiology. 2017;68(4):281–7.

    Article  PubMed  Google Scholar 

  3. Fernandez R, Zaky F, Ekmejian A, Curtis E, Lee A. Safety and efficacy of ulnar artery approach for percutaneous cardiac catheterization: systematic review and meta-analysis. Catheter Cardiovasc Interv. 2018;91(7):1273–80.

    Article  PubMed  Google Scholar 

  4. Ruiz-Rodriguez E, Asfour A, Lolay G, Ziada KM, Abdel-Latif AK. Systematic review and meta-analysis of major cardiovascular outcomes for radial versus femoral access in patients with acute coronary syndrome. S Med J. 2016;109(1):61.

    Article  Google Scholar 

  5. Andò G, Porto I, Montalescot G, Bolognese L, Trani C, Oreto G, et al. Radial access in patients with acute coronary syndrome without persistent ST-segment elevation: systematic review, collaborative meta-analysis, and meta-regression. Int J Cardiol. 2016;222:1031–9.

    Article  PubMed  Google Scholar 

  6. Piccolo R, Galasso G, Capuano E, De Luca S, Esposito G, Trimarco B, et al. Transradial versus transfemoral approach in patients undergoing percutaneous coronary intervention for acute coronary syndrome: a meta-analysis and trial sequential analysis of randomized controlled trials. PLoS One. 2014;9(5):e96127.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Kolkailah AA, Alreshq RS, Muhammed AM, Zahran ME, El-Wegoud MA, Nabhan AF. Transradial versus transfemoral approach for diagnostic coronary angiography and percutaneous coronary intervention in people with coronary artery disease. Cochrane Database Syst Rev. 2018;4:1.

    Google Scholar 

  8. Mason PJ, Shah B, Tamis-Holland JE, Bittl JA, Cohen MG, Safirstein J, et al. An update on radial artery access and best practices for transradial coronary angiography and intervention in acute coronary syndrome: a scientific statement from the American Heart Association. Circ Cardiovasc Interv. 2018;11(9):e000035.

    Article  PubMed  Google Scholar 

  9. Feldman DN, Swaminathan RV, Kaltenbach LA, Baklanov DV, Kim LK, Wong SC, et al. Adoption of radial access and comparison of outcomes to femoral access in percutaneous coronary intervention: an updated report from the national cardiovascular data registry (2007–2012). Circulation. 2013;127(23):2295–306.

    Article  PubMed  Google Scholar 

  10. Rigattieri S, Valsecchi O, Sciahbasi A, Tomassini F, Limbruno U, Marchese A, et al. Current practice of transradial approach for coronary procedures: a survey by the Italian Society of Interventional Cardiology (SICI-GISE) and the Italian Radial Club. Cardiovasc Revasc Med. 2017;18(3):154–9.

    Article  PubMed  Google Scholar 

  11. Plourde G, Pancholy SB, Nolan J, Jolly S, Rao SV, Amhed I, et al. Radiation exposure in relation to the arterial access site used for diagnostic coronary angiography and percutaneous coronary intervention: a systematic review and meta-analysis. The Lancet. 2015;386(10009):2192–203.

    Article  Google Scholar 

  12. Giannopoulos G, Raisakis K, Synetos A, Davlouros P, Hahalis G, Alexopoulos D, et al. A predictive score of radial artery spasm in patients undergoing transradial percutaneous coronary intervention. Int J Cardiol. 2015;188:76–80.

    Article  PubMed  Google Scholar 

  13. Hamon M, Pristipino C, Di Mario C, Nolan J, Ludwig J, Tubaro M, et al. Consensus document on the radial approach in percutaneous cardiovascular interventions: position paper by the European Association of Percutaneous Cardiovascular Interventions and Working Groups on Acute Cardiac Care and Thrombosis of the European Society of Cardiology. EuroIntervention. 2013;8(11):1242–51.

    Article  PubMed  Google Scholar 

  14. Caputo RP, Tremmel JA, Rao S, Gilchrist IC, Pyne C, Pancholy S, et al. Transradial arterial access for coronary and peripheral procedures: executive summary by the transradial committee of the SCAI. Catheter Cardiovasc Interv. 2011;78(6):823–39.

    Article  PubMed  Google Scholar 

  15. Toomath S, Arnott C, Patel S. Radial first in primary percutaneous coronary intervention—ensuring at-risk groups aren’t left behind. Heart Lung Circulation. 2022.

  16. Trilla M, Freixa X, Regueiro A, Fernández-Rodriguez D, Brugaletta S, Martin-Yuste V, et al. Impact of aging on radial spasm during coronary catheterization. J Invasive Cardiol. 2015;27(12):E303–7.

    PubMed  Google Scholar 

  17. Gorgulu S, Norgaz T, Karaahmet T, Dagdelen SJJ. Incidence and predictors of radial artery spasm at the beginning of a transradial coronary procedure. J Interv Cardiol. 2013;26(2):208–13.

    Article  PubMed  Google Scholar 

  18. Goldsmit A, Kiemeneij F, Gilchrist IC, Kantor P, Kedev S, Kwan T, et al. Radial artery spasm associated with transradial cardiovascular procedures: results from the RAS registry. Catheter Cardiovasc Interv. 2014;83(1):E32–6.

    Article  PubMed  Google Scholar 

  19. Omaygenç MO, Karaca İO, İbişoğlu E, Özer Ü, Çakal B, Güneş HM, et al. Comparing of efficacy of different self-assessment anxiety scales for predicting radial artery spasm during coronary interventions. Turkiye Klinikleri Cardiovascular Sciences. 2019.

  20. Ercan S, Unal A, Altunbas G, Kaya H, Davutoglu V, Yuce M, et al. Anxiety score as a risk factor for radial artery vasospasm during radial interventions: a pilot study. Angiology. 2014;65(1):67–70.

    Article  PubMed  Google Scholar 

  21. Aoun J, Hattar L, Dgayli K, Wong G, Bhat T. Update on complications and their management during transradial cardiac catheterization. Expert Rev Cardiovasc Ther. 2019;17(10):741–51.

    Article  CAS  PubMed  Google Scholar 

  22. Youn YJ, Kim W-T, Lee J-W, Ahn S-G, Ahn M-S, Kim J-Y, et al. Eutectic mixture of local anesthesia cream can reduce both the radial pain and sympathetic response during transradial coronary angiography. Korean Circ J. 2011;41(12):726–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Vuurmans T, Hilton D. Brewing the right cocktail for radial intervention. Indian Heart J. 2010;62(3):221–5.

    PubMed  Google Scholar 

  24. Rosencher J, Chaib A, Barbou F, Arnould MA, Huber A, Salengro E, et al. How to limit radial artery spasm during percutaneous coronary interventions: the spasmolytic agents to avoid spasm during transradial percutaneous coronary interventions (SPASM3) study. Catheter Cardiovasc Interv. 2014;84(5):766–71.

    Article  PubMed  Google Scholar 

  25. Curtis E, Fernandez R, Lee A. The effect of vasodilatory medications on radial artery spasm in patients undergoing transradial coronary artery procedures: a systematic review. JBI Database Syst Rev Implem Rep. 2017;15(7):1952–67.

    Article  Google Scholar 

  26. 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(5):475–83.

    Article  PubMed  Google Scholar 

  27. Spielberger C. State-Trait Anxiety Inventory (Form Y). Palo Alto, California: Mind Garden; 1983.

  28. Trotter R, Gallagher R, Donoghue JJH. Anxiety in patients undergoing percutaneous coronary interventions. Heart Lung. 2011;40(3):185–92.

    Article  PubMed  Google Scholar 

  29. Astin F, Jones K, Thompson DRJH. Prevalence and patterns of anxiety and depression in patients undergoing elective percutaneous transluminal coronary angioplasty. Heart Lung. 2005;34(6):393–401.

    Article  PubMed  Google Scholar 

  30. Khalili N, Karvandian K, Ardebili HE, Eftekhar N, Nabavian OJA, Care C. Predictive factors of preoperative anxiety in the anesthesia clinic: a survey of 231 surgical candidates. Arch Anesthesiol Crit Care. 2019;5:122.

    Google Scholar 

  31. Tulloch I, Rubin J. Assessment and management of preoperative anxiety. J Voice. 2019;33(5):691–6.

    Article  PubMed  Google Scholar 

  32. CD S. Manual for the State-Trait Anxiety Inventory STAI (form Y)("Self evaluation questionnaire"). 1983.

  33. Corp I. IBM SPSS Statistics for Windows,. Armonk, NY IBM Corp; 2020.

  34. Livingston EHJJ. Introducing the JAMA guide to statistics and methods. JAMA. 2014;312(1):35.

    Article  CAS  Google Scholar 

  35. Mong K, Duggan JA, Tabrizchi RJTA. Comparative study of functional responses and morphometric state of distal radial arteries in male and female. Ann Thorac Surg. 2002;74(6):2126–31.

    Article  PubMed  Google Scholar 

  36. Ho HH, Jafary FH, Ong P. Radial artery spasm during transradial cardiac catheterization and percutaneous coronary intervention: incidence, predisposing factors, prevention, and management. Cardiovasc Revasc Med. 2012;13(3):193–5.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Not applicable.

Funding

No funding was received for this study.

Author information

Authors and Affiliations

Authors

Contributions

RF, EC, AL, JW and JK contributed to the design of the study and development of the survey. EC, AL, JW and JK participated in the collection of the data. RF and EC carried out data analysis. RF, EC, AL, JK, EH contributed to the writing of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Elizabeth Curtis.

Ethics declarations

Ethical approval and consent to participate

Ethical approval was obtained from the UOW and local hospital Human Research Ethics Committee. All methods were carried out within the guidelines set out via the ethics committee approval. Informed consent was obtained from participants prior to the completion of the survey.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The original online version of this article was revised: there is a change in the author group and in the Ethics statement.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Curtis, E., Fernandez, R., Khoo, J. et al. Clinical predictors and management for radial artery spasm: an Australian cross-sectional study. BMC Cardiovasc Disord 23, 33 (2023). https://doi.org/10.1186/s12872-023-03042-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12872-023-03042-z

Keywords