Arterial Spasm, Coronary Artery Disease
Conditions
Keywords
radial spasm, percutaneous coronary intervention, vasodilatory drugs
Brief summary
Radial artery access use in percutaneous cardiac interventions (PCI) is associated with a lower risk of vascular complications, bleeding and major adverse cardiac events including cardiac death in the long-term follow-up. Intra-radial administration of vasodilatory drugs, transiently painful for the patient, reduces the risk of spasm and is currently the standard technique performed worldwide. However, the efficacy of intravenous administration of vasodilatory drugs has never been evaluated.
Detailed description
Multicenter, randomised controlled trial, designed to evaluate the noninferiority of the intravenous administration of vasodilatory drugs in comparison with the actual gold standard intra-arterial radial route, in terms of radial artery diameter increase. All consecutive patients with stable ischemic disease or stable acute coronary syndrome (NSTEMI - Non-ST elevation myocardial infarction) for whom a coronary procedure is planned will be included in the study. Three groups will be constituted. For all groups, the diameters of both radial arteries will be measured thrice by echo-Doppler: 5 minutes before sheath insertion, immediately before sheath insertion and 5 minutes after sheath insertion. Pain evaluation will be performed after injection of the vasodilatory drugs/placebo in the radial artery: * Group 1 (control group): intra-radial administration of the vasodilatory drugs after sheath insertion (verapamil 2.5 mg + isosorbide dinitrate 0.5 mg) * Group 2 (intravenous-post): intra-venous administration of the vasodilatory drugs after sheath insertion (verapamil 2.5 mg + isosorbide dinitrate 0.5 mg) * Group 3 (intravenous-pre): intra-venous administration of the vasodilatory drugs 5 minutes before sheath insertion (verapamil 2.5 mg + isosorbide dinitrate 0.5 mg)
Interventions
OTHERIntravenous administration of vasodilatory drugs
Administration of the vasodilatory drugs in a different pattern than intra-arterially
Sponsors
Centre de recherche clinique - FBM-CHUV
University of Lausanne Hospitals
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Caregiver)
Intervention model description
Multi-center randomised controlled trial
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Clinical indication for a coronary angiogram by radial route 2. Age ≥18 years old 3. Chronic coronary disease or stable acute coronary syndrome (NSTEMI, Non-ST Elevation Myocardial Infarction)
Exclusion criteria
1. ST-Elevation Myocardial infarction 2. Severe aortic stenosis (aortic valve area \<0.8 cm2 or mean gradient \> 40 mmHg) 3. Severe left ventricular dysfunction (left ventricular ejection fraction \< 30%). 4. Heart failure, hemodynamic instability or severe hypotension (systolic arterial pressure \< 90 mm Hg or heart rate \< 45 bpm). 5. Atrioventricular disturbances (atrioventricular block 2° or 3°). 6. Contraindications to the class of drugs used in the trial, e.g. known hypersensitivity or allergy to class of drugs or the investigational 7. Women who are pregnant or breast feeding, Lack of safe contraception, defined as: Female participants of childbearing potential, not using and not willing to continue using a medically reliable method of contraception for the entire study duration, such as oral, injectable, or implantable contraceptives, or intrauterine contraceptive devices, or who are not using any other method considered sufficiently reliable by the investigator in individual cases. 8. Other clinically significant concomitant disease states (e.g., renal failure, hepatic dysfunction, cardiovascular disease, etc.), 9. Psychological disorders, dementia, etc. of the participant.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Maximal radial artery diameter dilation, measured by echo-doppler, after administration of vasodilatory drugs by intravenous or intra-radial route. | 5 minutes after vasodilatory drugs administration | Radial artery diameter |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pain evaluation after vasodilatory drugs administration using the intravenous versus intra-radial route | Procedure (During vasodilatory drugs administration) | Scale from 0 to 10, lower values corresponding to lower pain and higher values to intense pain. |
| Hemodynamic changes after vasodilatory drugs administration using the intravenous versus intra-radial route | 5 minutes after vasodilatory drugs administration | Measure of arterial pressure |
| Heart rate change after vasodilatory drugs administration using the intravenous versus intra-radial route | 5 minutes after vasodilatory drugs administration | Measure of heart rate. |
Countries
Switzerland
Outcome results
None listed