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Transdermal Nitroglycerin Patch as a Potential Pretreatment to Prevent Radial Artery Spasm During Transradial Cardiac Catheterization
Case Report
A 71-year-old female was hospitalized due to suspected coronary artery stenosis on multislice computed tomography. Elective coronary angiography was performed via the left distal radial artery. A 0.021˝ guidewire for sheath insertion could not be advanced into radial artery due to its tortuosity and multiple stenoses (Figure 1A). Following careful manipulation of the guidewire, it finally passed through (Video 1). Due to significant stenosis in her left anterior descending artery, percutaneous coronary intervention (PCI) was performed 1 month after this procedure. Her left radial was selected again for the PCI due to occlusion of her brachiocephalic artery. Because we thought that radial artery vasospasm may cause stenosis, a nitroglycerin transdermal patch (27 mg) was placed on her left forearm 12 hours prior to PCI in hopes of reducing stenosis (Figure 1B). Subsequent angiography showed no stenosis within the left radial artery and substantial dilation (Figure 1C). Advancement of the guidewire and insertion of a 6 Fr sheath were easily performed without any patient discomfort (Video 2).
A recent guideline has recommended the radial artery as the access site for coronary catheterization due to lower risk of bleeding and vascular complications. However, the transradial approach is not necessarily easily performed due to the smaller vessel diameter and more frequent occurrence of vasospasm induced by the procedure. The previous study demonstrated that subcutaneous nitroglycerine injection at the radial artery puncture site dilated the radial artery by using the measurement in ultrasound, while a patch is easier and less invasive. The current case suggests the applicability of a nitroglycerin transdermal patch to prevent vasospasm via local transdermal absorption into the arterial wall, which may lead to a higher success rate for the transradial approach, especially in patients who had experienced radial artery vasospasm.
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Affiliations and Disclosures
From the 1Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; and 2the Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.
Manuscript accepted March 28, 2021.
The authors report that patient consent was provided for publication of the image used herein.
Address for correspondence: Masashi Fujino, MD, PhD, Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan. Email: fujinom@ncvc.go.jp
