Impact of Aging on Radial Spasm During Coronary Catheterization.

AIMS: To assess the impact of aging on the incidence and severity of radial spasm during coronary catheterization. BACKGROUND: One of the main predictors for transradial approach failure during coronary catheterization is the occurrence of radial spasm. Although it has been suggested that radial spasm might be more common in old patients, the role of confounding factors in older populations and the intuitive thinking that younger patients are more prone to spasm render this debate still active. METHODS: This was a transversal study, which prospectively included consecutive patients referred to our center for elective coronary catheterization during a 6-month period. RESULTS: A total of 190 patients were included. The mean age was 67.9 ± 3.6 years and 130 (68%) were males. Overall, 32 (16.8%) presented with radial spasm. Patients with radial spasm were younger (64.8 ± 12.1 years vs 69.6 ± 12.6 years; P=.04). In the quartile analysis, the largest difference was observed between patients ≤61 years and those >80 years, who presented with a rate of spasm of 25.6% and 9.1%, respectively (P=.04). Multivariable analysis showed that the age of patients was inversely related to the occurrence of radial spasm, decreasing 3% with every additional year (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.94-0.99), and the number of catheters, increasing around 50% with every additional used catheter (OR, 1.54; 95% CI, 1.07-2.23). CONCLUSION: The main finding of the present paper is the inverse association between aging and radial spasm. The present study suggests the need to intensify preventive measures in young patients in order to reduce the incidence of radial spasm.

Right versus left transradial approach for coronary catheterization in octogenarian patients.

OBJECTIVES: The aim of the study was to evaluate if the left radial approach (LRA) confers any additional advantage compared to the right radial approach (RRA) in octogenarian patients who undergo a coronary diagnostic procedure. BACKGROUND: Octogenarians, an increasing segment of patients in our society, present a higher risk of access-site complications related to invasive coronary catheterization. Transradial approach has been shown to be an effective alternative to reduce vascular complications. Although some studies have suggested that elderly people might benefit from a LRA, the advantages of using the left or right radial access remain not clear. METHODS: One hundred octogenarian patients undergoing a transradial coronary angiogram with normal Allen test and without previous history of coronary artery by-pass grafting were randomized to either LRA (n = 50) or RRA (n = 50). The primary end-points of the study were procedural and fluoroscopy times. RESULTS: Mean age was 82.6 years (80-88) and 59% were males. Procedural and fluoroscopy times were similar among study groups. Crossover was required in two patients (4%) with RRA and five patients (10%) with LRA (P = 0.24). Subclavian tortuosity was more frequent in the right side (32% vs. 6% in the left side; P = 0.002) but this difference did not translate into longer procedural or fluoroscopy times or higher cross-over, procedural difficulty or wire manipulation. CONCLUSIONS: In our series of octogenarian patients, the LRA was a valid alternative for diagnostic procedures but its usage was not associated with a significant reduction in procedural and fluoroscopy times compared to the RRA.