Naslov
The effect of preprocedural application of topical medications on the radial artery dilation and occurrence of vasospasm in patients undergoing transradial angiography

Autori
Fylling, Lisa

Vrsta, podvrsta i kategorija rada
Ocjenski radovi, diplomski rad, diplomski

Fakultet
Medicinski fakultet

Mjesto
Split

Datum
13.09

Godina
2022

Stranica
51

Mentor
Borovac, Josip Anđelo

Ključne riječi
coronary angiography ; transradial ; diagnostic catheterisation ; stable coronary disease, CAD ; intervention ; EMLA ; prilocaine ; lidocaine ; arterial spasm ; vasospasm ; radial spasm ; pain ; cannulation

Sažetak
Objectives: The present study aimed to examine whether the application of topical cutaneous medication, compared to standard subcutaneous lidocaine infiltration, prior to radial artery puncture in the setting of diagnostic coronary angiography will impact the occurrence of radial artery spasm, pain experienced by the patient during the procedure, and mean attempts of radial artery cannulation. Patients and methods: Cumulative meta-analysis of data derived from 7 randomized controlled or prospective non-randomized placebo- controlled trials was performed. The primary outcomes of interest included relative risk of radial artery spasm during cannulation, mean pain score as perceived by the patient and quantified by visual analogue scale, and mean radial artery cannulation attempts. Risk ratio (RR) with 95% confidence intervals (95% CI) was used for the effect measurement of radial artery spasm while fixed effects method was applied. The mean difference was calculated by using the random effects model due to data exhibiting moderate to high heterogeneity. Meta-analysis was performed by using the Cochrane’s Review Manager software. Results: The data derived from seven studies enrolling a total of 1425 patients were included in the analysis. A total of 106 radial artery spasm events were recorded. Radial artery spasm occurred in 5.57% of cases in the experimental arm (topical solution), while in the arm receiving standard treatment radial vasospasm occurred in 9.32% of cases. This yielded a relative risk reduction of 41% in patients receiving topical medication (RR 0.59 ; 95% CI 0.41 to 0.86, P=0.005), compared to control arm. Analysis of 1342 patients from 6 studies in regards to pain quantified by VAS, the results showed a significant reduction in pain score by 1.54 points (MD -1.54 ; 95% CI -2.94 to -0.14 points, P=0.030) among patients that received topical medications vs. standard treatment. The mean number of radial artery cannulation attempts were recorded in 4 studies, including 744 patients. The results showed -0.07 fewer cannulation attempts in the experimental vs. control arm (MD - 0.07, 95% CI -0.14 to 0.01), however, this result was not statistically significant (P=0.070). Conclusions: Preprocedural application of topical cutaneous medication, compared to standard-of-care consisting of subcutaneous lidocaine infiltration, prior to radial artery cannulation in the setting of transradial angiography in patients with stable or suspected CAD was associated with a significant reduction in the occurrence of radial spasm and pain perceived by the patient. Application of topical cutaenous medication, however, did not reduce the mean number of radial artery cannulation attempts, when compared to subcutaneous lidocaine infiltration.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA