None listed
Conditions
Brief summary
A transradial arterial approach is being used more frequently for coronary angiography due to the lower vascular complications and lower bleeding rates reported in recent large trials. Radial artery spasm, subclavian tortuosity and the increased technical difficulty of puncturing a smaller and more mobile artery are causes for access failure. This prospective randomised placebo controlled trial aims to look at the role of subcutaneous glyceryl trinitrate, as a vasodilatory agent, injected prior to arterial puncture to improve the technique. Radial artery diameter change will be assessed using ultrasound at the site of injection as well as the contralateral side to review for a systemic effect. Time to successful arterial access will be recorded and patient satisfaction in the form of pain scores will also be recorded.
Interventions
The intervention will be a subcutaneous injection of glyceryl trinitrate (GTN) prior to radial artery puncture as part of a coronary angiogram. One millilitre (1ml) GTN (500 micrograms / millilitre) with 1ml lidocaine 2% will be used once only. This injection will be provided by the blinded operator performing the procedure.
Sponsors
Royal Brisbane & Women's Hospital
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Subject, Caregiver)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patient attending for a planned coronary angiogram – outpatient or inpatient Planned for transradial approach
Exclusion criteria
Presentation requiring emergent coronary angiography including ST-elevation myocardial infarction (STEMI) Cardiogenic shock Requiring inotropic support or intra-aortic balloon pump insertion Known severe aortic stenosis Known left ventricular outflow tract obstruction (including hypertrophic cardiomyopathy) No transthoracic echocardiogram in the month prior to procedure Systolic blood pressure <90mmHg at the time of the procedure Previous intolerance or reaction to glyceryl trinitrate Known history of glaucoma or stroke or significant head trauma Phosphodiesterase inhibitor (e.g. Sildenafil / Tadalafil) use in the preceding 4 days Have been on regular long-acting nitrates in the previous 48 hours
Outcome results
None listed