This case described the successful treatment of
catheter entrapment due to severe radial artery spasm
that accompanies vasospastic angina with a simple
and effective non-pharmacological technique. Radial
artery is mainly composed of smooth muscle cells
together with alpha-adrenoceptor-predominance
which explains the specific susceptibility to
vasospasm.[
4] Circulating catecholamines mainly
activate alpha-1-adrenoreceptor. Patient-related
factors such as small size and anomalous origin of
the radial artery, female sex, younger age, short
stature, and anxiety were defined as predisposing
factors for radial artery spasm during transradial approach.[
3] In the present report, our case was young
and suffered from anxiety. The majority of previous
reports advocated nitrate derivative or verapamil
to prevent spasm of radial artery; however, there is
currently no consensus on the optimal agents.[
3] As in
our case, we use intra-arterial nitroglycerin for such
patients on a regular basis.
In addition, heating has been shown to be a
stimulus evoking the conduit artery dilatation.
Previously, it has been demonstrated that heating
may induce radial artery vasodilation through
the flow-mediated dilatation.[5,6] Increased
local temperature has been also documented to
modulate alpha-1-adrenergic receptor-mediated
vasoconstriction by increasing the release of
endothelial cell-derived vasodilators.
Moreover, several studies have suggested
hyperreactivity to adrenergic stimulation triggering
coronary artery spasm in patients with vasospastic
angina. Type A behavior pattern, severe anxiety
and panic disorders were described as some of the
predisposing factors for vasospastic angina. Previous
studies have suggested that vasospastic angina is
associated with migraine and Raynaud phenomenon.[7,8]
These observations have stimulated the hypothesis
that some of the patients with vasospastic angina have
generalized vasospastic disorder.[7,8] The predisposing
factors and hyperreactivity to adrenergic stimulation
may account for the common underlying mechanism
for vasospastic angina and radial artery spasm. Radial
artery spasm may be also considered as a part of the clinical presentation of generalized arterial
vasospasm. However, definitive evidences supporting
such an association are not available. As it may be
a coincidental catheter-induced radial artery spasm.
Further studies are warranted to establish a conclusion.
In conclusion, we suggest that forearm heating
may effectively reverse severe and pharmaco-resistant
vasospasm of radial artery during a transradial
intervention in patients with vasospastic angina.
Acknowledgement
We would like to thank Osman Konencoglu,
catheterization lab technician for his contribution to
the present report.
Declaration of conflicting interests
The authors declared no conflicts of interest with
respect to the authorship and/or publication of this
article.
Funding
The authors received no financial support for the
research and/or authorship of this article.
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