Author + information
- Muhammad S. Azzouz,
- Saurabh Aggarwal,
- Abhilash Akinapelli,
- Toufik Mahfood Haddad,
- Manu Kaushik and
- Michael Del Core
Radial access has become the preferred access in coronary angiography. Radial artery spasm (RAS) remains a challenge in some of these cases resulting in transfemoral conversion. Various intra-arterial vasodilators like calcium channel blockers (CCB) have been used to help decreasing RAS. We therefore conducted this meta analysis to investigate the effects of calcium channel blockers on RAS.
We searched PubMed, Cochrane Library & Web of Science for randomized studies comparing the administration of intra-arterial CCB (Including Verapamil or Diltiazem) versus placebo on RAS. The primary outcome assessed was the incidence of RAS. Unfortunately, we were unable to evaluate other secondary outcomes like hypotension, pain and bradycardia as they were not reported in most of the studies. We conducted our metaanalysis using the random effects model. Visual inspection of the funnel plot showed publication bias. P value less than 0.05 was considered statistically significant.
A total 6 randomized studies with a total of 2067 patients (CCB arm:1144; Placebo arm: 923) were included in the final analysis. CCB administration resulted in significant decrease in the rate of RAS (OR 0.37 [0.26-.52], P < 0.0001). The outcomes remained positive with fixed effects model analysis. There was no difference between both interventions after running sensitivity analysis.
Calcium channel blockers help reducing radial artery spasm in radial interventions. Large studies are needed to form a more specific consensus of dosage and potential side effects of these medications.