Journal Article

Topical Nitroglycerin for Radial Access Optimization: Supporting Vascular Access in Patients at Risk for Acute Heart Failure

Nișulescu, Daniel, Lazăr, Mihai-Andrei, Zus, Adrian Sebastian, Crișan, Simina, Luca, Constantin-Tudor, Valcovici, Mihaela, Văcărescu, Cristina, Pătru, Oana, Luca, Silvia, Gaiță, Dan

2025

Overview

Background and Objectives: Radial artery spasm (RAS) is a frequent complication during invasive angiography using the transradial approach, leading to patient discomfort and procedural challenges. While intra-arterial nitroglycerine (NTG) effectively reduces RAS after sheath insertion, preprocedural prevention strategies are limited. This study evaluates the efficacy of topical NTG in improving radial artery puncture success and reducing RAS incidence. Materials and Methods: In a randomized, double-blind single-center study 100 patients undergoing angiography were pretreated with either topical NTG or placebo. Outcomes assessed included RAS incidence, radial artery puncture success, number of attempts, procedural duration, patient discomfort, and complications. RAS was evaluated angiographically and clinically, with additional subgroup analyses for diabetic and smoking patients. Results: Topical NTG significantly reduced RAS incidence (53.2% vs. 73.6%; p = 0.0349) and increased radial puncture success on the first attempt (89.4% vs. 77.4%; p = 0.0488). Diabetic patients particularly benefited from NTG application, with lower RAS rates (36.4% vs. 76.2%; p = 0.0296). No significant differences were observed in procedural duration, patient discomfort, or complication rates between groups. The placebo group demonstrated a higher incidence of diffuse RAS (p = 0.0109). Conclusions: Preprocedural topical NTG application is a safe, non-invasive intervention that improves radial artery access success and reduces RAS, especially in high-risk subgroups such as diabetics. These findings support its potential as a procedural optimization tool in cardiovascular interventions, particularly in patients with heart failure, who often require repeated and reliable vascular access.

• Publisher: MDPI AG,MDPI
• Subject: Administration, Topical / Aged / Anesthesia / Angiography / Cardiac catheterization / Care and treatment / Catheters / coronary angiography / Diabetes / Dosage and administration / Double-Blind Method / Ejection fraction / Female / Health aspects / Heart failure / Heart Failure - prevention & control / Humans / Ischemia / Male / Medical imaging / Methods / Middle Aged / Mortality / nitric oxide / Nitroglycerin / Nitroglycerin - administration & dosage / Nitroglycerin - pharmacology / Nitroglycerin - therapeutic use / Pain / Patients / Physiological aspects / Quality management / Radial artery / Radial Artery - drug effects / Radial Artery - physiopathology / radial artery spasm / Software / Spasm - etiology / Spasm - prevention & control / Topical medication / topical nitroglycerine / transradial access / Vasoconstriction / Vasodilator Agents - administration & dosage / Vasodilator Agents - therapeutic use / Veins & arteries / Venous access