Use of diltiazem as an antispasmodic drug in coronary angiography via

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Document on Subject : "Use of diltiazem as an antispasmodic drug in coronary angiography via"— Transcript:

1 Use of diltiazem as an antispasmodic dru
Use of diltiazem as an antispasmodic drug in coronary angiography via the transradial approacharterial sheath, which is part of the routine used in transra-nary ultrasound study of the radial artery. The right radial Co.) 23-cm long with an external diameter of 2.3 mm.After sheath insertion into the artery, 5,000 UI of sodiumright coronary artery, Judkins 3.5 curve for the left coronaryartery, and a pigtailcatheter. We evaluated the procedureduration from the introduction of the sheath until its removal,with monumental flow release through the radial artery.After this maneuver, a compression dressing in X wasFive) linear transducer with a suitable vascular protocol by(post-late) the performance of coronary angiography. Invian, axillary, brachial and ulnar arteries. The analysis of theradial artery is made through the calculation of the systolicvolume (pulse Doppler). We performed Allens maneuverobserved retrograde flow in the ulnar artery. Ultrasound fin-chi-square test and Fishers exact test. Data were expressedoutput before, 30 minutes after, and 7 to 10 days after coro- test. Statistical significance 23) or diltiazem 27) prior to coronary angiography through a radialthe 50 cases analyzed with selective catheterization of the(85.2%) in GII. Two catheters were used in only 1 patientin 5 patients from GI (21.7%) and 4 patients from GII (14.8%).Subclavian, axillary, brachial, ulnar, and radial arteriescoronary angiography, and 2.350.47 mm (1.6 to 3.51 mm)0.73). Regarding GII, the previous diameter Table I Clinical characteristics of patients (n=50)Group IGroup IIP (n=23

2 )(n=27)58.69.2754.79.090.13Male gender
)(n=27)58.69.2754.79.090.13Male gender18 (78.3%)19 (70.4%)28.13.827.053.8Blood hypertension18 (78.3%)17 Diabetes4 (17.4%)3 (11.1%)Smoking7 (30.4%)11 (40.7%)Dyslipidemia10 (43.5%)7 Familial history of11 (47.8%)13 (48.1%)0.9Stable angina12 (52.2%)17 (63%)Unstable angina5 (21.7%)4 (14.8%)Postinfarction6 (26.1%)6 (22.2%) Use of diltiazem as an antispasmodic drug in coronary angiography via the transradial approachgraphy, P=0.039 (fig. 3). The systolic peak velocity of thegraphy, the radial artery diameter observed was 2.41pectively, with no statistically significant difference bet-We observed a slight hematoma in at the site of punc-days. Vascular complications observed in this sample werepatent in the later analysis, whereas the case in which thethe procedure. We did not observe the presence of great justifying greater duration of coronary angiography. after examination, according to its diameter increase. Such phenomenon is not Fig. 4 A) Bi-dimensional ultrasound image of right radial artery with normal Group I (placebo)Group II (diltiazem)Group I (placebo)Group II (diltiazem) Use of diltiazem as an antispasmodic drug in coronary angiography via the transradial approach and adapted for therapeutic study,administered during the procedure and, mainly, because of comparing radial and femoralvascular surgery: 4.4% femoral x 0% radial). Therefore, theclavian artery, which is more difficult to achieve than aorto-iliac tortuosity, hindering the finalization of the procedureTable II Local radial artery complications assessed after 30 minutes Group IGroup IIGroup IGroup II (n=

3 23)(n=27)(n=23)(n=27)Spasm1 (4.3%)000Occ
23)(n=27)(n=23)(n=27)Spasm1 (4.3%)000Occlusion1 (4.3%)01 (4.3%)0Partial obstruction2 (8.7%)03 (12.9%)0 in 10.4% of patients, and only 2% nee-ded to change to the femoral access. Vasodilator drugsto avoid spasm vary considerably, according to the perso-500 g) of one over another, related to decreasing spasm or otherplied effectively by the ulnar artery, is tested before the pro-zation rate after 1 month in 40 to 60% of the cases showedflow disturbance was 23%. We observed in this study thatIn the present study, in the group that used diltiazem,the diameter, considered a risk factor for occlusion, and theter, with a consequent decrease in its occlusion rate. It isTo Dr. Angela Tavares Paes for cooperation in the sta- Use of diltiazem as an antispasmodic drug in coronary angiography via the transradial approach Cardiologia Av. Dr. Dante Pazzanese, 500 12 - 04012-180 So Paulo, SP E-mail: slnbraga@cardiol.br Arq Bras Cardiol, volume 81 (n 1), 59-63, 2003Jos Ronaldo MontAlverne Filho, Joo Alexandre Rezende Assad, Alexandre do Canto Zago,Ricardo Leite Vieira da Costa, Antonio Guarany MontAlverne Pierre, Mohamed Hassan Saleh,Rodrigo Barretto, Srgio Luiz Navarro Braga, Fausto Feres, Amanda Guerra Moraes Rego Sousa, So Paulo, SP - BrazilComparative Study of the Use of Diltiazem as an Antispasmodic or therapeutic 1.Campeau L. Percutaneous radial artery approach for coronary angiography -2.Kiemeneij F, Laarman GJ. Percutaneous transradial artery approach for coronary3.D’Urbano M, Cafiero F. Percutaneous radial approach for coronary angiographv.4.Kiemeneij F, La

4 arman GJ, Slagboom T, et al. Outpatient
arman GJ, Slagboom T, et al. Outpatient coronary stent5.Hildick-Smith DJR, Lowe MD, Walsh JT, et al. Coronary Angiography from the6.Ludman PF, Stephens NG, Harcombe A, et al. Radial versus femoral approach for7.Safian RD, Freed MS. The Manual of Interventional Cardiology. 38.Louvard Y, Lefevre T, Allaim A, et al. Coronary angiography through the radialor the femoral approach: The CARAFE Study. Cathet Cardiov Interv 2001; 52:9.Kiemeneij F, Laarman GJ, Odekerken D, et al. A randomized comparison offemoral approaches: The ACCESS Study. J Am Coll Cardiol 1997; 29: 1269-75.10.Mann T, Cubeddu C, Bowen J, et al. Stenting in acute coronary syndromes: a11.Choussat R, Black A, Bossi A, et al. Efficacy and safety of percutaneousin patients treated by abciximab. Am J Cardiol 1999; 22: 35P.12.Kiemeneij F, Laarman GJ, Melker E. Transradial artery coronary angioplasty. Am13.Nagai S, Abe S, Sato T, et al. Ultrasonic assessment of vascular complications in14.Stella P, Kiemeneij F, Laarman G, et al. Incidence and outcome of radial arteryocclusion following transradial artery coronary angioplasty. Circulation 1995;15.Byers J, Brown S, Robertson R, et al. Procedural outcome and clinical results after16.Hall JJ, Arnold AM, Valentine RP, et al. Ultrasound imaging of the radial artery Editor da Seção de Fotografias Artísticas: Cícero Piva de Albuquerque Correspondência: InCor - Av. Dr. Enéas C. Aguiar, 44 - 05403-000 - São Paulo, SP - E-mail: delcicero@incor. usp.br 1.Campeau L. Percutaneous radial artery approach for coronary angiography -2.Kiemeneij F, Laarman GJ. Percutaneous transradial

5 artery approach for coronary3.D’Urb
artery approach for coronary3.D’Urbano M, Cafiero F. Percutaneous radial approach for coronary angiographv.4.Kiemeneij F, Laarman GJ, Slagboom T, et al. Outpatient coronary stent5.Hildick-Smith DJR, Lowe MD, Walsh JT, et al. Coronary Angiography from the6.Ludman PF, Stephens NG, Harcombe A, et al. Radial versus femoral approach for7.Safian RD, Freed MS. The Manual of Interventional Cardiology. 38.Louvard Y, Lefevre T, Allaim A, et al. Coronary angiography through the radialor the femoral approach: The CARAFE Study. Cathet Cardiov Interv 2001; 52:9.Kiemeneij F, Laarman GJ, Odekerken D, et al. A randomized comparison offemoral approaches: The ACCESS Study. J Am Coll Cardiol 1997; 29: 1269-75.10.Mann T, Cubeddu C, Bowen J, et al. Stenting in acute coronary syndromes: a11.Choussat R, Black A, Bossi A, et al. Efficacy and safety of percutaneousin patients treated by abciximab. Am J Cardiol 1999; 22: 35P.12.Kiemeneij F, Laarman GJ, Melker E. Transradial artery coronary angioplasty. Am13.Nagai S, Abe S, Sato T, et al. Ultrasonic assessment of vascular complications in14.Stella P, Kiemeneij F, Laarman G, et al. Incidence and outcome of radial arteryocclusion following transradial artery coronary angioplasty. Circulation 1995;15.Byers J, Brown S, Robertson R, et al. Procedural outcome and clinical results after16.Hall JJ, Arnold AM, Valentine RP, et al. Ultrasound imaging of the radial artery Editor da Seção de Fotografias Artísticas: Cícero Piva de Albuquerque Correspondência: InCor - Av. Dr. Enéas C. Aguiar, 44 - 05403-000 - São Paulo, SP - E-mail: delcicero@incor. usp.b