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Eslami G, Golshani S, Moosazadeh M, Shadfar F. Intra-Arterial Labetalol and Nitroglycerin in Preventing Radial Artery Spasm Following Transradial Angiography: A New Approach. PHARMACEUTICAL SCIENCES 2020. [DOI: 10.34172/ps.2020.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background:
Radial artery spasm (RAS) resulted from decreasing blood flow and activation of vasomotor system leads to a decrease in artery diameter, perfusion and patency, and increase the risk of procedure failure. In this study, we investigated the effects of intra-arterial administration of nitroglycerin and labetalol on radial artery diameter, RAS, and pain intensity in patients undergoing diagnostic radial angiography. Methods: Sixty-four patients randomly enrolled into one of the nitroglycerin (150 μg) or labetalol (500 μg) groups. The radial artery size, and the incidence of RAS were measured before, immediately after puncture, and at the end of treatment. Pain intensity was evaluated using a visual-analog-scale (VAS) at the end of the procedure. Hemodynamic status before, and during the procedure was also recorded. Results: Labetalol causes a significantly larger increase in radial diameter than nitroglycerin immediately after intra-arterial injection (2.24±0.58 mm vs. 1.65±0.39 mm, P-value<0.001). The rate of RAS immediately after vasodilator administration in the labetalol group was 3.1% vs. 12.5% in the nitroglycerin group (P-value=0.355), but the overall incidence (immediately after administration+ at the end of procedure) did not show a statistically significant difference (53.125% vs 31.25% respectively, P-value=0.076). The VAS score did not show a significant difference between two groups (1.15±0.44 in nitroglycerin vs. 1.50±0.91, P-value=0.063). Conclusion: Labetalol increases radial artery diameter more than nitroglycerin. However, the efficacy of labetalol in terms of RAS incidence, and patients’ pain was similar to nitroglycerin. Therefore, intra-arterial labetalol could be considered as one of the therapeutic options in clinical practice in order to reduce RAS and procedure failure.
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Affiliation(s)
- Gohar Eslami
- Department of Clinical Pharmacy, Faculty of Pharmacy, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Samad Golshani
- Department of Cardiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmood Moosazadeh
- Health Sciences Research Center, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
| | - Faezeh Shadfar
- Department of Clinical Pharmacy, Faculty of Pharmacy, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
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Yin A, Yamada A, Stam WB, van Hasselt JGC, van der Graaf PH. Quantitative systems pharmacology analysis of drug combination and scaling to humans: the interaction between noradrenaline and vasopressin in vasoconstriction. Br J Pharmacol 2018; 175:3394-3406. [PMID: 29859008 DOI: 10.1111/bph.14385] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 05/27/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND PURPOSE Development of combination therapies has received significant interest in recent years. Previously, a two-receptor one-transducer (2R-1T) model was proposed to characterize drug interactions with two receptors that lead to the same phenotypic response through a common transducer pathway. We applied, for the first time, the 2R-1T model to characterize the interaction of noradrenaline and arginine-vasopressin on vasoconstriction and performed inter-species scaling to humans using this mechanism-based model. EXPERIMENTAL APPROACH Contractile data were obtained from in vitro rat small mesenteric arteries after exposure to single or combined challenges of noradrenaline and arginine-vasopressin with or without pretreatment with the irreversible α-adrenoceptor antagonist, phenoxybenzamine. Data were analysed using the 2R-1T model to characterize the observed exposure-response relationships and drug-drug interaction. The model was then scaled to humans by accounting for differences in receptor density. KEY RESULTS With receptor affinities set to published values, the 2R-1T model satisfactorily characterized the interaction between noradrenaline and arginine-vasopressin in rat small mesenteric arteries (relative standard error ≤20%), as well as the effect of phenoxybenzamine. Furthermore, after scaling the model to human vascular tissue, the model also adequately predicted the interaction between both agents on human renal arteries. CONCLUSIONS AND IMPLICATIONS The 2R-1T model can be of relevance to quantitatively characterize the interaction between two drugs that interact via different receptors and a common transducer pathway. Its mechanistic properties are valuable for scaling the model across species. This approach is therefore of significant value to rationally optimize novel combination treatments.
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Affiliation(s)
- Anyue Yin
- Division of Systems Biomedicine and Pharmacology, Leiden Academic Centre for Drug Research (LACDR), Leiden University, Leiden, The Netherlands.,Department of Clinical Pharmacy and Toxicology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Akihiro Yamada
- Division of Systems Biomedicine and Pharmacology, Leiden Academic Centre for Drug Research (LACDR), Leiden University, Leiden, The Netherlands.,Clinical Pharmacology PKMS Group, Astellas Pharma Inc., Tokyo, Japan
| | - Wiro B Stam
- Dutch Ministry of Health and Sports, Den Haag, The Netherlands
| | - Johan G C van Hasselt
- Division of Systems Biomedicine and Pharmacology, Leiden Academic Centre for Drug Research (LACDR), Leiden University, Leiden, The Netherlands
| | - Piet H van der Graaf
- Division of Systems Biomedicine and Pharmacology, Leiden Academic Centre for Drug Research (LACDR), Leiden University, Leiden, The Netherlands.,Certara QSP, Canterbury, UK
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Engin E, Alp Yildirim Fİ, Kalelі Durman D, Ömeroğlu SN, Göksedef D, Teskіn Ö, Balkanay OO, İpek G, Uydeş Doğan BS. Relaxant effect of the prostacyclin analogue iloprost on isolated human radial artery: An approach for the reversal of graft spasm. Prostaglandins Other Lipid Mediat 2017; 133:35-41. [PMID: 29107024 DOI: 10.1016/j.prostaglandins.2017.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 10/10/2017] [Accepted: 10/17/2017] [Indexed: 10/18/2022]
Abstract
Radial artery graft spasm in the perioperative or postoperative period of coronary bypass surgery necessitates urgent treatment due to risk of graft failure and mortality. Herein, we evaluated the effect of iloprost, a prostacyclin (PGI2) analogue, against the contractions produced by noradrenaline and potassium chloride on isolated human radial artery. Following the determination of endothelial and vascular relaxing capacities of the arteries, iloprost (10-9M-10-6M) was cumulatively applied on rings precontracted submaximally with the spasmogens. In some rings, the response to iloprost was assessed following pretreatment with nitric oxide (NO) synthase inhibitor, l-NAME (3×10-4M,30min). Iloprost produced complete relaxations on radial artery rings precontracted with noradrenaline whereas, only moderate relaxations against the contractions induced by potassium chloride. Notably, the relaxation to iloprost was remarkably blunted in radial arteries with impaired endothelial function. Moreover, the relaxation to iloprost was unchanged in rings pretreated with l-NAME. Our results demonstrated that iloprost could be a potent relaxant agent in reversing radial artery spasm, particularly initiated by noradrenaline, possibly acting via an endothelium-mediated mechanism unrelated to NO.
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Affiliation(s)
- Ersoy Engin
- Department of Cardiovascular Surgery, Cerrahpaşa Medical Faculty, Istanbul, Turkey; Department of Cardiovascular Surgery, Şişli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - F İlkay Alp Yildirim
- Department of Pharmacology, Faculty of Pharmacy, Istanbul University, Istanbul, Turkey
| | - Deniz Kalelі Durman
- Department of Pharmacology, Faculty of Pharmacy, Istanbul University, Istanbul, Turkey
| | - Suat Nail Ömeroğlu
- Department of Cardiovascular Surgery, Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Deniz Göksedef
- Department of Cardiovascular Surgery, Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Önder Teskіn
- Biruni University, Faculty of Medicine, Department of Cardiovascular Surgery, Istanbul, Turkey
| | - Ozan Onur Balkanay
- Department of Cardiovascular Surgery, Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Gökhan İpek
- Department of Cardiovascular Surgery, Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - B Sönmez Uydeş Doğan
- Department of Pharmacology, Faculty of Pharmacy, Istanbul University, Istanbul, Turkey.
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4
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He GW, Taggart DP. Antispastic Management in Arterial Grafts in Coronary Artery Bypass Grafting Surgery. Ann Thorac Surg 2016; 102:659-68. [PMID: 27319987 DOI: 10.1016/j.athoracsur.2016.03.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 01/19/2016] [Accepted: 03/07/2016] [Indexed: 10/21/2022]
Abstract
Arterial grafts have long-term patency superior to vein grafts but have a tendency to develop spasm that can lead to potentially life-threatening complications. A perfect antispastic protocol should include advanced surgical technique and adequate pharmacologic methods. All pharmacologic vasodilator drugs relax the vessel through specific mechanisms, and therefore, there is no perfect, single best vasodilator to prevent or treat spasm of the arterial graft against all mechanisms of contraction. One of the choices is to use a combination of pharmacologic vasodilators targeting different mechanisms of spasm to obtain the reliable and best effect.
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Affiliation(s)
- Guo-Wei He
- Department of Cardiovascular Surgery and Center for Basic Medical Research, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin and Zhejiang University and The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China, and Department of Surgery, Oregon Health and Science University, Portland, Oregon.
| | - David P Taggart
- Department of Cardiothoracic Surgery, Oxford University, United Kingdom
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Sarac B, Korkmaz O, Altun A, Bagcivan I, Göksel S, Yildirim S, Berkan O. Investigation of the vasorelaxant effects of moxonidine and its relaxation mechanism on the human radial artery when used as a coronary bypass graft. Interact Cardiovasc Thorac Surg 2015; 21:342-5. [DOI: 10.1093/icvts/ivv136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 05/04/2015] [Indexed: 11/14/2022] Open
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Technical Issues in the Use of the Radial Artery as a Coronary Artery Bypass Conduit. Ann Thorac Surg 2014; 98:2247-54. [DOI: 10.1016/j.athoracsur.2014.07.039] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 07/06/2014] [Accepted: 07/09/2014] [Indexed: 11/20/2022]
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Baikoussis NG, Papakonstantinou NA, Apostolakis E. Radial artery as graft for coronary artery bypass surgery: Advantages and disadvantages for its usage focused on structural and biological characteristics. J Cardiol 2014; 63:321-8. [PMID: 24525045 DOI: 10.1016/j.jjcc.2013.11.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 11/01/2013] [Accepted: 11/14/2013] [Indexed: 10/25/2022]
Abstract
Radial artery (RA) is the most popular arterial graft after the left internal thoracic artery in both low- and high-risk patients undergoing coronary artery bypass grafting. Various arterial grafts such as the right internal thoracic artery, the right gastroepiploic artery, and the inferior epigastric artery have also gained ground over the past 30 years because of the intimal hyperplasia and atherosclerosis of the saphenous vein leading to late graft occlusion. In this review article we would like to present the utility of the RA as a graft, focused mainly on its structural and biological characteristics.
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Affiliation(s)
| | | | - Efstratios Apostolakis
- Department of Cardiac Surgery, Ioannina University Hospital, School of Medicine, Ioannina, Greece
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8
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One-Week Postoperative Patency of Lower Extremity In Situ Bypass Graft Comparing Epidural and General Anesthesia: Retrospective Study of 822 Patients. Ann Vasc Surg 2014; 28:295-300. [DOI: 10.1016/j.avsg.2013.01.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 01/09/2013] [Accepted: 01/15/2013] [Indexed: 11/20/2022]
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9
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He GW. Arterial grafts: clinical classification and pharmacological management. Ann Cardiothorac Surg 2013; 2:507-18. [PMID: 23977630 DOI: 10.3978/j.issn.2225-319x.2013.07.12] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 07/16/2013] [Indexed: 01/08/2023]
Abstract
In comparison with standard saphenous vein grafts, use of the internal mammary artery (IMA) as a coronary artery bypass graft has achieved superior long-term results. This is related to the differences in the biological characteristics between the venous and arterial grafts. However, even arterial grafts are not uniform in their biological characteristics. The variation in the perioperative behavior of the grafts and in their long-term patency may be related to different characteristics. These factors should be taken into account in the use of arterial grafts, some of which are subjected to more active pharmacological intervention during and after the operation to obtain satisfactory results. To better understand the biological behavior of the grafts, their common features and their differences, a clinical classification may be useful for a practicing surgeon. Based on experimental studies of their vasoreactivity combined with anatomical, physiological and embryological considerations, we have proposed a functional classification for arterial grafts that may be useful clinically. Our classification suggests that there are three types of arterial grafts: Type I-somatic arteries; Type II-splanchnic arteries; and Type III-limb arteries. Type I arteries have enhanced endothelial function and release more nitric oxide and other relaxing factors. Type II arteries, such as the gastro-epiploic artery, and Type III arteries, such as the radial artery (RA), have higher pharmacological reactivity to vasoconstrictors. This classification explains why the IMA has the best long-term patency. Because Type II and III arteries are prone to spasms due to higher contractility, they require more active pharmacological interventions. Furthermore, the harvesting technique of the conduits, including the saphenous vein and IMA, are described and discussed in this article. Prevention of spasms using two cocktails of medications (verapamil + nitroglycerin and nicardipine + nitroglycerin) during harvesting of the conduits is described. These solutions have been demonstrated to be clinically effective.
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Affiliation(s)
- Guo-Wei He
- TEDA International Cardiovascular Hospital, Tianjin & The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China; ; Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
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Ambrus N, Szolnoky J, Pollesello P, Kun A, Varró A, Papp JG, Pataricza J. Prolonged Antispasmodic Effect in Isolated Radial Artery Graft and Pronounced Platelet Inhibition Induced by the Inodilator Drug, Levosimendan. Basic Clin Pharmacol Toxicol 2011; 110:269-74. [DOI: 10.1111/j.1742-7843.2011.00801.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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11
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Riess ML, Ulrichs JG, Pagel PS, Woehlck HJ. Case report: Severe vasospasm mimics hypotension after high-dose intrauterine vasopressin. Anesth Analg 2011; 113:1103-5. [PMID: 21865499 DOI: 10.1213/ane.0b013e31822cef10] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Intramyometrial vasopressin injection reduces bleeding during myomectomy. Subsequent loss of peripheral pulses and nonmeasurable arterial blood pressure have been attributed to cardiovascular collapse or hypotension. When interpreted as global hypotension, treatment with vasopressors or according to Advanced Cardiac Life Support resuscitation protocols has been associated with cardiac complications. We describe a patient who developed loss of peripheral pulses and nonmeasurable blood pressure by noninvasive means after myometrial administration of 60 U vasopressin, with documented severe peripheral arterial vasospasm and elevated proximal blood pressure. We discuss the pathophysiology and emphasize the danger of misinterpreting pulselessness as global hypotension instead of vasospasm in this setting.
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Affiliation(s)
- Matthias L Riess
- Department of Anesthesiology, Medical College of Wisconsin, and Medical College of Wisconsin Affiliated Hospitals, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA.
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Laporte R, Kohan A, Heitzmann J, Wiśniewska H, Toy J, La E, Tariga H, Alagarsamy S, Ly B, Dykert J, Qi S, Wiśniewski K, Galyean R, Croston G, Schteingart CD, Rivière PJM. Pharmacological Characterization of FE 202158, a Novel, Potent, Selective, and Short-Acting Peptidic Vasopressin V1aReceptor Full Agonist for the Treatment of Vasodilatory Hypotension. J Pharmacol Exp Ther 2011; 337:786-96. [DOI: 10.1124/jpet.111.178848] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Conant AR, Simpson AW. Reply to Sadaba. Eur J Cardiothorac Surg 2009. [DOI: 10.1016/j.ejcts.2009.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Achouh PE, Simonet S, Fabiani JN, Verbeuren TJ. Carbon monoxide induces relaxation of human internal thoracic and radial arterial grafts. Interact Cardiovasc Thorac Surg 2008; 7:959-62. [PMID: 18697762 DOI: 10.1510/icvts.2008.180489] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Carbon monoxide is produced by the degradation of heme by intracellular heme-oxygenase. The aim of our study was to evaluate, in vitro, the vasodilating effect of carbon monoxide and its mechanisms of action on human internal thoracic and radial artery grafts. Segments of human internal thoracic artery and radial artery, obtained from isolated coronary artery bypass surgery patients, were studied in organ chambers. The arterial rings were precontracted with norepinephrine then submitted to carbon monoxide. Inhibitors of nitric oxide synthase and of soluble guanylate cyclase were added to some arterial rings. Carbon monoxide induced significant relaxation in precontracted human internal thoracic artery and radial artery rings. This relaxation was independent of the presence of functional endothelium in internal thoracic artery. Blocking soluble guanylate cyclase partially inhibited this relaxation, while blocking nitric oxide synthase had no effect. Carbon monoxide has a relaxing effect on human internal thoracic artery and radial artery grafts in vitro, partially via cyclic guanylate monophosphate (cGMP) pathway activation. Inducing carbon monoxide production at the cellular level in vivo in human arterial grafts might help prevent vasospasm.
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Affiliation(s)
- Paul E Achouh
- Department of Cardiothoracic and Vascular Surgery, European Hospital Georges Pompidou, Paris, France.
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A new antispastic solution for arterial grafting: nicardipine and nitroglycerin cocktail in preparation of internal thoracic and radial arteries for coronary surgery. J Thorac Cardiovasc Surg 2008; 136:673-80, 680.e1-2. [PMID: 18805271 DOI: 10.1016/j.jtcvs.2007.12.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2007] [Revised: 11/05/2007] [Accepted: 12/24/2007] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Antispastic protocols for arterial grafts are important in arterial grafting for coronary artery bypass grafting surgery. We designed a new nicardipine and nitroglycerin cocktail that is composed of a second-generation dihydropyridine calcium antagonist, nicardipine and nitroglycerin (30 micromol/L), and examined its effect in human internal thoracic and radial arteries. METHODS Human internal thoracic (n = 86) and radial (n = 74) artery segments from 72 patients undergoing coronary artery bypass grafting were studied. Relaxation against 3 classic vasoconstrictors (potassium chloride, thromboxane A(2) mimetic U46619, and alpha-adrenoceptor agonist norepinephrine) and prophylactic effect on contraction against these vasoconstrictors were examined. The effect of the nicardipine and nitroglycerin cocktail on the endothelial function in internal thoracic and radial arteries was studied in response to acetylcholine. RESULTS Nicardipine and nitroglycerin induced almost full relaxation (92.2% +/- 4.7% to 97.9% +/- 1.0%, P < .001 in internal thoracic arteries and 95.4% +/- 1.9% to 96.7% +/- 3.3%, P < .001 in radial arteries, n = 6-8) against 3 vasoconstrictors with significant prophylactic effect on contraction (maximal contraction was depressed to 32.5% to 76.4%, P < .05 or P < .001, and EC50s were increased to 5 to 42-fold more, P < .01). After treatment with the nicardipine and nitroglycerin cocktail, the acetylcholine-induced relaxation was unchanged (P > .05). CONCLUSION The use of the nicardipine and nitroglycerin cocktail provides a new antispastic protocol that has rapid onset, full relaxation, and excellent prophylactic effect against all known mechanisms of vasospasm and maximally protects the endothelial and smooth muscle function of the internal thoracic and radial arteries. The cocktail is therefore expected to provide a new method in treating grafts in coronary artery bypass grafting with the best antispastic effect and protection of the graft.
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Attaran S, John L, El-Gamel A. Clinical and Potential Use of Pharmacological Agents to Reduce Radial Artery Spasm in Coronary Artery Surgery. Ann Thorac Surg 2008; 85:1483-9. [PMID: 18355566 DOI: 10.1016/j.athoracsur.2007.10.042] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2007] [Revised: 10/09/2007] [Accepted: 10/10/2007] [Indexed: 11/17/2022]
Affiliation(s)
- Saina Attaran
- Department of Cardiothoracic Surgery, Kings College Hospital, London, United Kingdom
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Barner HB. Operative Treatment of Coronary Atherosclerosis. Ann Thorac Surg 2008; 85:1473-82. [DOI: 10.1016/j.athoracsur.2008.01.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2007] [Revised: 01/02/2008] [Accepted: 01/02/2008] [Indexed: 01/06/2023]
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Berkan O, Bagcivan I, Kaya T, Yildirim K, Yildirim S, Doğan K. Investigation of the vasorelaxant effects of 3-(5'-hydroxymethyl-2'-furyl)-1-benzyl indazole (YC-1) and diethylamine/nitric oxide (DEA/NO) on the human radial artery used as coronary bypass graft. Can J Physiol Pharmacol 2007; 85:521-6. [PMID: 17632587 DOI: 10.1139/y07-033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The radial artery (RA) is used as a spastic coronary bypass graft. This study was designed to investigate the mechanism of vasorelaxant effects of YC-1 (3-(5'-hydroxymethyl-2'-furyl)-1-benzyl indazole), a nitric oxide (NO)-independent soluble guanylate cyclase (sGC) activator, and DEA/NO (diethylamine/nitric oxide), a NO-nucleophile adduct, on the human RA. RA segments (n = 25) were obtained from coronary artery bypass grafting patients and were divided into 3-4 mm vascular rings. Using the isolated tissue bath technique, the endothelium-independent vasodilatation function was tested in vitro by the addition of cumulative concentrations of YC-1 (10-10 to 3 x 10-7 mol/L) and DEA/NO (10-8 to 3 x 10-5 mol/L) following vasocontraction by phenylephrine in the presence or absence of 10-5 mol/L ODQ (1H-(1,2,4)oxadiazole(4,3-a)quinoxalin-1-one), the selective sGC inhibitor, 10-7 mol/L iberiotoxin, a blocker of Ca2+-activated K+ channels, or 10-5 mol/L ODQ plus 10-7 mol/L iberiotoxin. We also evaluated the effect of YC-1 and DEA/NO on the cGMP levels in vascular rings obtained from human radial artery (n = 6 for each drug). YC-1 (10-10 to 3 x 10-7 mol/L) and DEA/NO (10-8 to 3 x 10-5 mol/L) caused the concentration-dependent vasorelaxation in RA rings precontracted with phenylephrine (10-5 mol/L) (n = 20 for each drug). Pre-incubation of RA rings with ODQ, iberiotoxin, or ODQ plus iberiotoxin significantly inhibited the vasorelaxant effect of YC-1, but the inhibitor effect of ODQ plus iberiotoxin was significantly more than that of ODQ and iberiotoxin alone (p < 0.05). The vasorelaxant effect of DEA/NO almost completely abolished in the presence of ODQ and iberiotoxin plus ODQ, but did not significantly change in the presence of iberiotoxin alone (p > 0.05). The pEC50 value of DEA/NO was significantly lower than those for YC-1 (p < 0.01), with no change Emax values in RA rings. In addition, YC-1-stimulated RA rings showed more elevation in cGMP than that of DEA/NO (p < 0.05). These findings indicate that YC-1 is a more potent relaxant than DEA/NO in the human RA. The relaxant effects of YC-1 could be due to the stimulation of the sGC and Ca2+-sensitive K+channels, whereas the relaxant effects of DEA/NO could be completely due to the stimulation of the sGC. YC-1 and DEA/NO may be effective as vasodilator for the short-term treatment of perioperative spasm of coronary bypass grafts.
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Affiliation(s)
- Ocal Berkan
- Department of Cardiovascular Surgery, Cumhuriyet University School of Medicine, 58140 Sivas, Turkey.
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Kulik A, Rubens FD, Gunning D, Bourke ME, Mesana TG, Ruel M. Radial Artery Graft Treatment With Phenoxybenzamine is Clinically Safe and May Reduce Perioperative Myocardial Injury. Ann Thorac Surg 2007; 83:502-9. [PMID: 17257977 DOI: 10.1016/j.athoracsur.2006.09.089] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2006] [Revised: 09/25/2006] [Accepted: 09/26/2006] [Indexed: 11/20/2022]
Abstract
BACKGROUND Phenoxybenzamine effectively reduces radial artery (RA) spasm in vitro, but clinical data supporting its use during coronary revascularization are lacking. Therefore, the purpose of this study was to evaluate the clinical safety and efficacy of RA treatment with phenoxybenzamine. METHODS Data were collected prospectively on 698 patients who underwent coronary artery bypass grafting with a RA between 1997 and 2005. Of these, 311 patients received RA grafts incubated in 2 mg/mL phenoxybenzamine for 15 minutes, and 387 patients received RA grafts treated with verapamil and nitroglycerin (VG solution). Demographic, operative, and postoperative data were compared retrospectively using multivariate regression techniques. RESULTS The incidence of perioperative myocardial events (defined as either low cardiac output syndrome or perioperative myocardial infarction) was significantly reduced in the phenoxybenzamine group (6.8% vs 11.9%, phenoxybenzamine vs VG solution; p = 0.03). Perioperative myocardial enzyme release, as measured by postoperative maximum creatine kinase, was also reduced in the phenoxybenzamine group (743.0 +/- 677.9 vs 937.2 +/- 1236.8 U/L, phenoxybenzamine vs VG solution; p = 0.014). After adjusting for patient and procedural factors, the use of phenoxybenzamine was independently associated with reductions in peak creatine kinase (by -343.0 +/- 136.7 U/L; p = 0.012) and peak troponin T level (by -0.50 +/- 0.19 ng/mL; p = 0.010). No differences in vasopressor support, length of stay, or other complications were observed. CONCLUSIONS Treatment of RA grafts with phenoxybenzamine was associated with a reduction in perioperative myocardial injury and adverse cardiac events in this study population. Investigations to further evaluate the potential benefits of phenoxybenzamine in randomized settings are warranted.
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Affiliation(s)
- Alexander Kulik
- Division of Cardiac Surgery, University of Ottawa, Ottawa, Ontario, Canada
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Oo AY, Conant AR, Chester MR, Dihmis WC, Simpson AWM. Temperature Changes Stimulate Contraction in the Human Radial Artery and Affect Response to Vasoconstrictors. Ann Thorac Surg 2007; 83:126-32. [PMID: 17184643 DOI: 10.1016/j.athoracsur.2006.08.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2005] [Revised: 08/17/2006] [Accepted: 08/18/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND Radial artery conduits are increasingly used in coronary artery bypass grafting as an additional arterial graft to the internal thoracic artery. Their reactive nature remains a concern, often necessitating the routine use of topically applied vasodilators, such as glyceryl trinitrate, papaverine, phenoxybenzamine, or calcium channel antagonists, in theatre. During preparation prior to surgery and grafting, radial artery conduits are exposed to cooling and rewarming. We investigated how these temperature changes would affect radial artery contractility and how commonly used topical treatments might be used to prevent this. METHODS Human radial artery was obtained excess to surgery and arterial sections used in organ bath tension experiments or for the culture of smooth muscle cells from medial explants. RESULTS The radial artery responded to rapid cooling by the addition of 22 degrees C buffer with contraction. Gradual cooling, over a 20 to 30 minute period, reduced basal tension and the response to potassium chloride (KCl) and noradrenaline. Subsequent rewarming from 22 degrees C to 37 degrees C reestablished contraction at precooled levels and led to an elevation of the basal tension. Increases in tension measured in the radial artery were paralleled by increases in intracellular calcium in smooth muscle cells. Contraction induced by rapid temperature changes could be blocked by glyceryl trinitrate but not by phenoxybenzamine. Papaverine and calcium channel blockers had only limited activity. CONCLUSIONS Temperature changes commonly encountered in theatre during the preparation of radial artery grafts are likely to cause contraction. If rapid temperature change cannot be avoided during graft preparation, then topically applied glyceryl trinitrate will block these responses.
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Affiliation(s)
- Aung Y Oo
- The Cardiothoracic Centre, University of Liverpool, Liverpool, United Kingdom
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Iino K, Tomita S, Higashidani K, Ujiie T, Arai S, Watanabe G. Successful Coronary Revascularization Using the PAS-Port System in a Patient With Takayasu’s Arteritis and Behcet’s Disease. Ann Thorac Surg 2006; 82:1889-91. [PMID: 17062268 DOI: 10.1016/j.athoracsur.2006.02.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2006] [Revised: 02/26/2006] [Accepted: 02/27/2006] [Indexed: 11/30/2022]
Abstract
Coronary artery disease is rare in patients with Takayasu's arteritis or Behcet's disease. We report the case of a patient with concomitant Takayasu's arteritis and Behcet's disease who had angina pectoris develop due to severe narrowing of the left main coronary artery. The patient underwent revascularization with saphenous vein grafts with the assistance of the PAS-Port Proximal Anastomosis System (Cardica, Inc, Redwood City, CA). In conclusion, the PAS-Port Proximal Anastomosis System seems to be a safe and effective method of facilitating revascularization, particularly when severe calcification of the ascending aorta precludes cross-clamping during off-pump coronary artery bypass grafting.
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Affiliation(s)
- Kenji Iino
- Department of General and Cardiothoracic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan.
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Nisanoglu V, Battaloglu B, Ozgur B, Eroglu T, Erdil N. Topical Vasodilators for Preventing Radial Artery Spasm during Harvesting for Coronary Revascularization: Comparison of 4 Agents. Heart Surg Forum 2006; 9:E807-12. [PMID: 16893753 DOI: 10.1532/hsf98.20061070] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND There is still controversy about which vasodilator solution is best for storing radial artery (RA) conduits prior to coronary artery bypass grafting. The aim of this pilot study was to investigate how 4 different topical vasodilators applied during RA harvesting affect blood flow with the vessel in situ. MATERIALS AND METHODS The subjects were 85 patients who underwent RA harvesting in preparation for coronary artery bypass grafting. Each case was assigned to 1 of 5 groups (17 RAs each) that were treated with different solutions: normal saline (control), nitroglycerin, diltiazem, papaverine, and adenosine. Standard clinical concentrations were used. The RA was partially harvested (pedicle attached proximally) and flow rates and hemodynamic parameters (mean arterial pressure, heart rate, central venous pressure) were recorded at 2 time points: (1) pretreatment and (2) after 5 minutes of immersion in 60 mL of treatment solution. Results were compared within and between groups, and post-treatment-to-pretreatment ratios were calculated for each variable. RESULTS There were no significant differences among the groups' mean pretreatment flow rates (P = .979) or mean posttreatment flow rates (P = .069). All except the diltiazem group showed a significant rise in mean flow rate from pretreatment to posttreatment. The mean posttreatment-to-pretreatment ratios for RA flow rate were 1.28 +/- 0.39 in the saline group, 1.85 +/- 0.72 in the nitroglycerin group, 1.31 +/- 0.48 in the diltiazem group, 1.37 +/- 0.64 in the papaverine group, and 1.23 +/- 0.42 in the adenosine group. Only the mean flow ratio in the nitroglycerin group was significantly higher than that in the saline group (P = .003). The mean flow ratios in the other vasodilator groups were not statistically different from the flow ratio in the saline group. CONCLUSIONS These preliminary results indicate that topical application of nitroglycerin solution effectively prevents perioperative spasm of the RA in patients undergoing coronary artery bypass surgery. The authors recommend this solution for preparation and storage of RA grafts. Randomized controlled trials with power analysis will give more definitive information.
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Affiliation(s)
- Vedat Nisanoglu
- Department of Cardiovascular Surgery, Inonu University, Turgut Ozal Medical Center, Malatya, Turkey.
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Gursoy S, Bagcivan I, Yildirim MK, Berkan O, Kaya T. Vasorelaxant effect of opioid analgesics on the isolated human radial artery. Eur J Anaesthesiol 2006; 23:496-500. [PMID: 16507200 DOI: 10.1017/s0265021506000172] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2006] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE Arterial grafts are prone to vasospasm. Opioid analgesics are commonly used in the perioperative course of cardiac surgical procedures. Therefore, we investigated the direct effects of morphine, meperidine, fentanyl and remifentanil on the human radial artery. METHODS Radial artery segments, obtained from 20 patients, were precontracted with phenylephrine. Using the organ bath technique, the endothelium-independent vasodilatation was tested in vitro by addition of cumulative concentrations of morphine, meperidine, fentanyl and remifentanil in separate organ baths, in the presence or absence of naloxone. Indomethacin and NG-nitro-L-arginine methyl ester was added to all organ bath in order to determine the effects of prostaglandins and nitric oxide, respectively. RESULTS Morphine (10(-8) - 10(-4) mol L-1), meperidine (10(-10) - 10(-6) mol L-1), fentanyl (10(-10) - 10(-6) mol L-1) and remifentanil (10(-8) - 10(-4) mol L-1) caused a concentration-dependent vasorelaxation in the human being artery rings. The relaxations in the presence of naloxane did not change. The maximal relaxant effects of meperidine and fentanyl were significantly greater than those of morphine and remifentanil (P < 0.05). CONCLUSIONS These findings indicate that morphine, meperidine, fentanyl and remifentanil produce concentration-dependent and endothelium-independent relaxations in human being radial artery rings. Meperidine and fentanyl are more potent relaxant agents than morphine and remifentanil in the human being radial artery in vitro.
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Affiliation(s)
- S Gursoy
- Department of Anesthesiology, Cumhuriyet University School of Medicine, Sivas, Turkey.
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Gursoy S, Berkan O, Bagcivan I, Kaya T, Yildirim K, Mimaroglu C. Effects of intravenous anesthetics on the human radial artery used as a coronary artery bypass graft. J Cardiothorac Vasc Anesth 2006; 21:41-4. [PMID: 17289478 DOI: 10.1053/j.jvca.2005.11.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2005] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Intravenous anesthetics are often used for anesthesia, sedation, and analgesia in the intraoperative and postoperative periods of coronary artery bypass graft (CABG) surgery. This study was designed to investigate the direct effects of intravenous anesthetics on the human radial artery (RA). DESIGN In vitro, prospective with repeated measures. SETTING University research laboratory. PARTICIPANTS RA segments (n = 20) were obtained from CABG surgery patients and were divided into 3- to 4-mm vascular rings. INTERVENTIONS Using the organ bath technique, the endothelium-independent vasodilatation function was tested in vitro by the addition of cumulative concentrations of thiopental, ketamine, etomidate, and propofol after vasocontraction by phenylephrine in the presence of N(G)-nitro-L-arginine methyl ester (L-NAME) and indomethacin. MEASUREMENTS AND MAIN RESULTS Thiopental (10(-8) to 10(-4) mol/L), ketamine(10(-8) to 10(-4) mol/L), propofol (10(-8) to 3 x 10(-4) mol/L), and etomidate (10(-8) to 3 x 10(-4) mol/L) caused concentration-dependent vasorelaxation in human RA rings precontracted with phenylephrine in the presence of L-NAME and indomethacin (n = 20, for each drug). The pEC(50) and maximum relaxant effect values of thiopental and ketamine were significantly higher than for etomidate and propofol (p < 0.05). CONCLUSIONS These findings indicate that thiopental, ketamine, etomidate, and propofol produce concentration-dependent relaxation on RA rings from humans. Thiopental and ketamine are more potent relaxant agents than etomidate and propofol. Intravenous anesthetics may be effective as alternative vasodilators for treatment of intraoperative and postoperative spasm of coronary artery grafts.
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Affiliation(s)
- Sinan Gursoy
- Department of Anesthesiology, Cumhuriyet University School of Medicine, Sivas, Turkey
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Manabe S, Sunamori M. Radial Artery Graft for Coronary Artery Bypass Surgery: Biological Characteristics and Clinical Outcome. J Card Surg 2006; 21:102-14; 115. [PMID: 16426364 DOI: 10.1111/j.1540-8191.2006.00182.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The radial artery (RA) is gaining popularity as a bypass conduit for coronary artery bypass grafting, and its impact on clinical practice has been extensively explored. In the present article, we provide a review of postoperative hand circulation, vascular biological characteristics of the RA graft, the efficacy of vasodilator therapies, and mid-term clinical results of use of the RA graft. Fundamental studies revealed excellent vascular biological characteristics of the RA graft as a living arterial conduit, making it almost equivalent to the internal thoracic artery (ITA) graft. Clinical studies have yielded encouraging mid-term results. Most studies reported in favor of the RA graft over the saphenous vein graft with regard to patency rate, freedom from cardiac events, and survival. However, superiority of either the RA or right ITA graft has not been conclusively determined. The long-term results of RA grafts remain unknown, but at present, supplementary use of an RA graft with a left ITA graft appears feasible for CABG.
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Affiliation(s)
- Susumu Manabe
- Department of Cardiothoracic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-Ku, Tokyo 113-8519, Japan.
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Frazier AA, Qureshi F, Read KM, Gilkeson RC, Poston RS, White CS. Coronary Artery Bypass Grafts: Assessment with Multidetector CT in the Early and Late Postoperative Settings. Radiographics 2005; 25:881-96. [PMID: 16009813 DOI: 10.1148/rg.254045151] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Coronary artery bypass graft (CABG) surgery is the standard of care in the treatment of advanced coronary artery disease. It is well known that the long-term clinical outcome after myocardial revascularization depends on the patency of the bypass grafts. In the past, invasive coronary angiography was used to assess the status of the grafts and check for graft occlusion. Recently, computed tomography (CT), particularly multidetector CT with electrocardiographic gating, has emerged as an important diagnostic tool for evaluation of CABGs in both the early (< or =1 month) and late (>1 month) postoperative settings. A variety of postoperative complications may manifest as dyspnea and chest pain, thereby mimicking recurrent angina secondary to graft occlusion. Owing to its improved spatial resolution compared with that of earlier-generation CT scanners and its ability to produce three-dimensional and multiplanar images, multidetector CT has assumed an integral role in characterization of graft patency while allowing investigation of alternative postoperative complications. In addition, the expanded capabilities of volumetric imaging may provide valuable information in preoperative planning for repeat CABG surgery.
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Affiliation(s)
- Aletta Ann Frazier
- Department of Diagnostic Imaging, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201, USA.
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Ruiz-Salmerón RJ, Mora R, Masotti M, Betriu A. Assessment of the efficacy of phentolamine to prevent radial artery spasm during cardiac catheterization procedures: A randomized study comparing phentolamine vs. verapamil. Catheter Cardiovasc Interv 2005; 66:192-8. [PMID: 15977263 DOI: 10.1002/ccd.20434] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The objective of this study was to evaluate phentolamine as radial artery spasmolytic in transradial catheterization procedures. Radial artery spasm is a relatively frequent complication during transradial approach, causing patient discomfort or even making it impossible to continue the procedure. As radial artery spasm is mediated by the stimulation of alpha-adrenoreceptors, the use of the alpha-blocker phentolamine could make sense as spasmolytic. We designed a randomized double-blind study to compare phentolamine vs. verapamil, the standard spasmolytic agent. Five hundred patients (250 in each arm) submitted to a transradial cardiac catheterization were consecutively included and randomly assigned to receive 2.5 mg of verapamil or 2.5 mg of phentolamine after sheath insertion. Both vasodilator agents induced a significant radial artery diameter increase (from 2.22 +/- 0.53 to 2.48 +/- 0.57 mm, P < 0.001 for verapamil, and from 2.20 +/- 0.53 to 2.45 +/- 0.53 mm, P < 0.001 for phentolamine). However, verapamil was more efficacious to prevent radial artery spasm (13.2% compared with 23.2% in phentolamine-treated patients; P = 0.004). Follow-up (20 +/- 18 days) evaluation of the radial artery patency by plestismography and pulse oximetry showed no differences between the two groups in the rate of radial occlusion (3.0% vs. 3.2% in verapamil and phentolamine treated patients, respectively). Phentolamine was an effective radial vasodilator agent, although it showed less ability to prevent radial artery spasm than verapamil. Radial artery occlusion rate was almost identical for both vasodilators. Thus, phentolamine could be a valid alternative to verapamil as a radial artery spasmolytic agent.
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Affiliation(s)
- Rafael J Ruiz-Salmerón
- Department of Interventional Cardiology, Hospital Clinic i Provincial, Barcelona, Spain.
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Tsuneyoshi I, Katai R, Hamasaki J, Onomoto M, Kanmura Y. Dopamine and radial artery: implications for clinical practice. Anesth Analg 2004; 99:1575. [PMID: 15502069 DOI: 10.1213/01.ane.0000137440.30019.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Isao Tsuneyoshi
- Department of Anesthesiology and Critical Care Medicine, Kagoshima University School of Medicine, Sakuragaoka, Kagoshima, Japan
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Daneshmand MA, Keller RS, Canver MC, Canver AC, Canver CC. Histamine H1 and H2 receptor–mediated vasoreactivity of human internal thoracic and radial arteries. Surgery 2004; 136:458-63. [PMID: 15300215 DOI: 10.1016/j.surg.2004.05.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although internal thoracic arteries (ITAs) and radial arteries (RAs) have been shown to have similar patency, RAs tend to be more vasospastic postoperatively compared with ITAs. Therefore, the purpose of this study was to examine the effect of histamine subclass 1 (H1) receptors and histamine subclass 2 (H2) receptors on vasoreactivity in human ITAs and RAs. METHODS Vessels were obtained from coronary artery bypass grafting patients. Human arterial rings (2 mm) were mounted in tissue baths, and baseline contractility was determined. Histamine concentration response curves (10(-9)-10(-3) mol/L) were performed in the absence or presence of diphenhydramine (H1 antagonist, 10(-4) mol/L) or famotidine (H2 antagonist, 10(-4) mol/L). Comparison of curves was performed by 2-way analysis of variance with repeated measures and a Bonferroni post-t test. RESULTS Maximal contraction to histamine was significantly greater in RA (8.3 +/- 0.8 g, n = 6) than in ITA (2.9 +/- 0.3, n = 6), (P < .05). However, there was no difference in sensitivity. Histamine-mediated responses of both RA and ITA were blocked by pre-exposure to H1 antagonist, whereas an H2 antagonist only partially inhibited RA responses while blocking most of the ITA response to histamine. CONCLUSION These studies suggest that H1 receptors alone cause contraction in RA but not in ITA, which may have potential linkage to patency and vasospasm. Further studies are necessary to identify the exact role of H2 receptors in ITA.
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Affiliation(s)
- Mani A Daneshmand
- Heart Institute and the Center for Cardiovascular Science, Albany Medical College, Albany, NY 12208, USA
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