Topical Nitroglycerin for Radial Access Optimization: Supporting Vascular Access in Patients at Risk for Acute Heart Failure
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Enrollment, Procedure Aspects, and Data Collection
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
TRA | Transradial access |
RAS | Radial artery spasm |
NTG | Nitroglycerine |
BSA | Body surface area |
LV | Left Ventricular |
NYHA | New York Heart Association |
CI | Confidence interval |
SD | Standard deviation |
IQR | Interquartile range |
RAO | Radial artery occlusion |
References
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All Patients N = 100 | Median | Median CI | Median SD | Minimum | Maximum |
---|---|---|---|---|---|
Height (centimeters) | 168.27 | 166.37 to 170.16 | 9.57 | 150 | 190 |
Procedure duration (minutes) | 26.43 | 22.57 to 30.30 | 19.27 | 3 | 133 |
Contrast used during procedure (milliliters) | 147.90 | 126.26 to 169.55 | 107.96 | 50 | 650 |
Pain score (based on Visual Analog Scale) | 3 | 3.0 to 4.0 | 2.27 | 0 | 9 |
Hospital stay duration (days) | 3.38 | 2.90 to 3.85 | 2.39 | 1 | 19 |
All patients N = 100 | Mean | Mean CI | Mean SD | Minimum | Maximum |
Age (years) | 62 | 60 to 67 | 11.23 | 32.00 | 88.00 |
Body mass index (kilograms/meters squared) | 28.07 | 27.56 to 29.30 | 4.77 | 16.89 | 40.62 |
Height (centimeters) | 170 | 166 to 170 | 9.57 | 150 | 190 |
Weight (kg) LV Ejection fraction (%) NYHA class | 80 45 2 | 77.44 to 83.27 40 to 50 2.0 to 2.0 | 14.94 11.15 0.67 | 46 15 1 | 118 65 4 |
Mean blood pressure (mmHg) | 115 | 110 to 120 | 17.75 | 65 | 165 |
Radial artery diameter indexed to body surface area (millimeters/meters squared) | 1.25 | 1.17 to 1.28 | 0.27 | 0.75 | 2.30 |
All Patients N = 100 | N = 100 (%) |
---|---|
Sex | male = 71/100 (71%) |
Presentation | Acute = 44/100 (44%) |
Diabetes mellitus | 32/100 (32%) |
Dyslipidemia | 95/100 (95%) |
Smoking | 36/100 (36%) |
Hypertension | 80/100 (80%) |
Previous radial intervention | 17/100 (17%) |
Radial artery pulse grade | 1/100—absent (1%) 34/100—weak (34%) 48/100—good (48%) 17/100—very good (17%) |
Radial artery puncture success and tries | 4/100—unsuccessful (4%) 83/100—first try (83%) 13/100—2 or more tries (13%) |
Crossover from radial to brachial/femoral access due to failed puncture | 4/100 (4%) |
Radial artery spasm | 63/100 (63%) |
Localized or diffuse spasm | Localized = 20/63 (31.7%) Diffuse = 43/63 (69.3%) |
Radial artery patency at discharge | 95/100 (95%) |
Hematoma at puncture site | 19/100 (19%) |
All Patients N = 100 | Cohort 1: NTG N = 47 Median | Cohort 1 Median CI | Cohort 1 IQR | Cohort 2: Placebo N = 53 Median | Cohort 2 Median CI | Cohort 2 IQR | p | CI |
---|---|---|---|---|---|---|---|---|
Height (centimeters) | 170 | 166.63 to 173.68 | 165 to 175 | 168 | 163.00 to 170.00 | 160.75 to 175.00 | p = 0.1168 | −6.0000 to 0.0000 |
Procedure duration (minutes) | 29 | 15.00 to 32.00 | 11.00 to 40.00 | 20 | 15.00 to 26.96 | 11.00 to 30.75 | p = 0.3276 | −10.0000 to 2.0000 |
Contrast used during procedure (milliliters) | 150 | 50 to 200 | 50 to 200 | 100 | 71 to 150 | 50 to 200 | p = 0.8069 | −50.0000 to 20.0000 |
Pain score (based on Visual Analog Scale) | 4 | 3 to 5 | 2 to 6 | 3 | 3 to 4 | 2 to 5.5 | p = 0.6489 | −1.0000 to 1.0000 |
Hospital stay duration (days) | 3 | 2.31 to 3.68 | 2 to 5 | 3 | 2.89 to 3.00 | 2 to 4 | p = 0.6136 | −1.0000 to 0.0000 |
All patients N = 100 | Cohort 1: NTG N = 47 Mean | Cohort 1 Mean CI | Cohort 1 Mean SD | Cohort 2: Placebo N = 53 Mean | Cohort 2 Mean CI | Cohort 2 Mean SD | p | CI |
Age (years) | 61.08 | 57.60 to 64.56 | 11.86 | 64.52 | 61.63 to 67.42 | 10.49 | p = 0.1267 | −1.02 to 7.91 |
Body mass index (kilograms/meters squared) | 28.56 | 27.33 to 29.80 | 4.20 | 28.94 | 27.48 to 30.39 | 5.2709 | p = 0.6992 | −1.5099 to 2.2552 |
Weight (kg) | 83.04 | 78.879 to 87.20 | 14.17 | 80.90 | 76.587 to 85.22 | 15.66 | p = 0.4757 | −8.0596 to 3.7859 |
LV Ejection fraction (%) | 45.38 | 42.41 to 48.35 | 10.11 | 43.53 | 40.22 to 46.84 | 12.02 | p = 0.409 | −2.54 to 6.25 |
NYHA class | 1.94 | 1.77 to 2.10 | 0.57 | 2.06 | 1.85 to 2.26 | 0.74 | p = 0.551 | −2.0 to 1.0 |
Mean blood pressure (mmHg) | 114.04 | 109.298 to 118.78 | 16.15 | 114.52 | 109.23 to 119.82 | 19.20 | p = 0.8922 | −6.6082 to 7.5797 |
Radial artery diameter (millimeters) | 2.44 | 2.30 to 2.57 | 0.44 | 2.46 | 2.31 to 2.62 | 0.53 | p = 0.7818 | −0.1718 to 0.2276 |
Radial artery diameter indexed to body surface area (millimeters/meters squared) | 1.24 | 1.17 to 1.31 | 0.23 | 1.30 | 1.21 to 1.39 | 0.31 | p = 0.352 | –0.85 to 0.68 |
All Patients N = 100 | Cohort 1: NTG N = 47 | Cohort 2: Placebo N = 53 | p |
---|---|---|---|
Sex | 11/47 (23.4%) female 36/47 (76.6%) male | 18/53 (34%) female 35/53 (66.0%) male | p = 0.2479 |
Acute/chronic presentation | 23/47 (48.9%) | 21/53 (60.4%) | p = 0.3515 |
Diabetes mellitus | 11 out of 47 (25.5%) | 21 out of 53 (39.6%) | p = 0.0842 |
Dyslipidemia | 45/47 (95.7%) | 50/53 (94.3%) | p = 0.7489 |
Smoking | 32/47 no (68.1%) 15/47 yes (31.9%) | 32/53 no (60.4%) 21/53 yes (39.6%) | p = 0.4229 |
Hypertension | 35/47 (74.5%) | 44/53 (83%) | p = 0.2972 |
Previous radial intervention | 11/47 (23.4%) | 6/53 (11.3%) | p = 0.1102 |
Radial artery pulse grade | 0 absent 12 weak (25.5%) 27 good (57.4%) 8 very good (17%) | 1 absent (1.9%) 22 weak (41.5%) 21 good (39.6%) 9 very good (17%) | p = 0.2208 |
Radial artery puncture success and tries | 0/47 unsuccessful 44/47 (89.4%) first try 3/47 (10.6%) 2 or more tries | 4/53 (7.5%) unsuccessful 41/53 (77.4%) first try 8/53 (15.1%) 2 or more tries | p = 0.0488 |
Crossover from radial to brachial/femoral access | 0/47 (0%) | 4/53 (7.5%) | p = 0.0546 |
Radial artery spasm | 25/47 (53.2%) | 39/53 (73.6%) | p = 0.0349 |
Localized or diffuse spasm | 12/25 localized (48.0%) 13/25 diffuse (52.0%) | 7/39 (17.9%) localized 32/39 diffuse (82.1%) | p = 0.0109 |
Radial artery patency at discharge | 46/47 (97.9%) | 48/53 (90.6%) | p = 0.1266 |
Hematoma at puncture site | 9/47 (19.1%) | 10/53 (18.9%) | p = 0.9716 |
Cohort 1 NTG with Diabetes Mellitus N = 11 | Cohort 2 Placebo with Diabetes Mellitus N = 21 | p | |
---|---|---|---|
Radial artery spasm | 4/11 (36.4%) | 16/21 (76.2%) | p = 0.0296 |
Cohort 1 NTG smoker N = 15 | Cohort 2 Placebo smoker N = 21 | ||
Radial artery spasm | 10/15 (66.6%) | 17/21 (80.9%) | p = 0.5580 |
Cohort 1 NTG Non smoker N = 32 | Cohort 2 Placebo Non smoker N = 32 | ||
Radial artery spasm | 15/32 (46.8%) | 22/32 (68.7%) | p = 0.1290 |
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Zus, A.S.; Crișan, S.; Luca, S.; Nișulescu, D.; Valcovici, M.; Pătru, O.; Lazăr, M.-A.; Văcărescu, C.; Gaiță, D.; Luca, C.-T. Topical Nitroglycerin for Radial Access Optimization: Supporting Vascular Access in Patients at Risk for Acute Heart Failure. Medicina 2025, 61, 1016. https://doi.org/10.3390/medicina61061016
Zus AS, Crișan S, Luca S, Nișulescu D, Valcovici M, Pătru O, Lazăr M-A, Văcărescu C, Gaiță D, Luca C-T. Topical Nitroglycerin for Radial Access Optimization: Supporting Vascular Access in Patients at Risk for Acute Heart Failure. Medicina. 2025; 61(6):1016. https://doi.org/10.3390/medicina61061016
Chicago/Turabian StyleZus, Adrian Sebastian, Simina Crișan, Silvia Luca, Daniel Nișulescu, Mihaela Valcovici, Oana Pătru, Mihai-Andrei Lazăr, Cristina Văcărescu, Dan Gaiță, and Constantin-Tudor Luca. 2025. "Topical Nitroglycerin for Radial Access Optimization: Supporting Vascular Access in Patients at Risk for Acute Heart Failure" Medicina 61, no. 6: 1016. https://doi.org/10.3390/medicina61061016
APA StyleZus, A. S., Crișan, S., Luca, S., Nișulescu, D., Valcovici, M., Pătru, O., Lazăr, M.-A., Văcărescu, C., Gaiță, D., & Luca, C.-T. (2025). Topical Nitroglycerin for Radial Access Optimization: Supporting Vascular Access in Patients at Risk for Acute Heart Failure. Medicina, 61(6), 1016. https://doi.org/10.3390/medicina61061016