Radial artery access site complications during cardiac procedures, clinical implications and potential solutions: The role of nitric oxide

Abstract

Percutaneous coronary intervention for the treatment of coronary artery disease is most commonly performed in the UK through the radial artery, as this is safer than the femoral approach. However, despite improvements in technology and techniques, complications can occur. The most common complication, arterial spasm, can cause intense pain and, in some cases, procedural failure. The incidence of spasm is dependent on several variables, including operator experience, artery size, and equipment used. An anti-spasmolytic cocktail can be applied to reduce spasm, which usually includes an exogenous nitric oxide (NO) donor (glyceryl trinitrate). NO is an endogenous local vasodilator and therefore is a potential target for anti-spasm intervention. However, systemic administration can result in unwanted side-effects, such as hypotension. A method that adopts local delivery of NO might be advantageous. This review article describes the mechanisms involved in radial artery spasm, discusses the advantages and disadvantages of current strategies to reduce spasm, and highlight the potential of NO-loaded nanoporous materials for use in this setting.

Keywords: Radial artery; Cannulation; Spasm; Nitric oxide; Vasodilation; Nanoporous material

Core tip: Radial access during interventional cardiology procedures is much safer than femoral access although complications can still arise. However, the radial artery is more prone to spasm which can cause pain for the patient and lead to procedural failure. Current strategies to avoid spasm include administration of an anti- spasmolytic cocktail. Several disadvantages towards the use of this “cocktail” leaves a gap in the industry for a new product to dilate the artery without any systemic effects.