{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T13:02:25Z","timestamp":1789650145721,"version":"4.0.0"},"reference-count":45,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004172","name":"Scientific Research Projects Coordination Unit of Mersin University","doi-asserted-by":"publisher","award":["2024-TP3-5117"],"award-info":[{"award-number":["2024-TP3-5117"]}],"id":[{"id":"10.13039\/501100004172","id-type":"DOI","asserted-by":"publisher"}]},{"award":["2024-TP3-5117"],"award-info":[{"award-number":["2024-TP3-5117"]}],"id":[{"id":"https:\/\/ror.org\/04nqdwb39","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Radial artery spasm (RAS) is a major complication of transradial coronary angiography (TRA) that adversely affects procedural success and patient comfort. Although procedural anxiety and pain contribute to RAS development, prospective randomized controlled data on the effect of virtual reality (VR) on RAS are limited. This study aimed to evaluate the effects of VR on anxiety, pain, and RAS during TRA. Methods: In this prospective, single-center, randomized controlled trial, 236 patients undergoing elective TRA were randomized 1:1 to the VR or control group. Following prespecified post-randomization exclusions, 130 patients (65 per group) were included in the per-protocol analysis. The intervention group received standardized VR content throughout the procedure. The primary endpoint was clinically assessed RAS; secondary endpoints included pre- and post-procedural state anxiety (STAI-S) and post-procedural pain measured using the visual analog scale (VAS). Results: Clinically assessed RAS occurred less frequently in the VR group than in the control group (7.7% vs. 52.3%, p &lt; 0.001). Post-procedural STAI-S and VAS scores were also lower in the VR group (both p &lt; 0.001). In an exploratory multivariable model, post-procedural STAI-S (OR, 1.29; 95% CI, 1.13\u20131.47; p &lt; 0.001) and VAS scores (OR, 3.44; 95% CI, 1.98\u20135.98; p &lt; 0.001) were associated with RAS. Because these variables were measured after the procedure, temporal direction and mediation cannot be inferred. Conclusions: In this single-center per-protocol analysis, VR use was associated with lower post-procedural anxiety and pain and a lower incidence of clinically assessed RAS during TRA. The large effect estimate should be interpreted cautiously because the intervention could not be blinded, the endpoint included subjective clinical features, and substantial post-randomization exclusions limit generalizability. Multicenter trials with blinded or objective endpoint corroboration and intention-to-treat analyses are warranted.<\/jats:p>","DOI":"10.3390\/jcm15187227","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T11:41:35Z","timestamp":1789645295000},"page":"7227","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of Virtual Reality on Anxiety, Pain, and Radial Artery Spasm During Transradial Coronary Angiography: A Prospective Randomized Controlled Trial"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4844-3946","authenticated-orcid":false,"given":"Ahmet Burak","family":"Ke\u00e7eci","sequence":"first","affiliation":[{"name":"Department of Cardiology, Tarsus State Hospital, 33460 Mersin, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4102-444X","authenticated-orcid":false,"given":"Emrah","family":"Ye\u015fil","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine, Mersin University, 33343 Mersin, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"ref_1","first-page":"e4","article-title":"2021 ACC\/AHA\/SCAI Guideline for Coronary Artery Revascularization: Executive Summary: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"145","author":"Lawton","year":"2022","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/j.ahj.2008.08.023","article-title":"Radial versus femoral access for coronary angiography or intervention and the impact on major bleeding and ischemic events: A systematic review and meta-analysis of randomized trials","volume":"157","author":"Jolly","year":"2009","journal-title":"Am. Heart J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1016\/j.ahj.2012.01.015","article-title":"Comparison of transradial and femoral approaches for percutaneous coronary interventions: A systematic review and hierarchical Bayesian meta-analysis","volume":"163","author":"Bertrand","year":"2012","journal-title":"Am. Heart J."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Zus, A.S., Cri\u0219an, S., Luca, S., Ni\u0219ulescu, D., Valcovici, M., P\u0103tru, O., Laz\u0103r, M.-A., V\u0103c\u0103rescu, C., Gai\u021b\u0103, D., and Luca, C.-T. (2024). Radial Artery Spasm\u2014A Review on Incidence, Prevention and Treatment. Diagnostics, 14.","DOI":"10.3390\/diagnostics14171897"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1157\/13074844","article-title":"Espasmo radial en el cateterismo card\u00edaco transradial. An\u00e1lisis de los factores asociados con su aparici\u00f3n y de sus consecuencias tras el procedimiento [Radial artery spasm in transradial cardiac catheterization. Assessment of factors related to its occurrence, and of its consequences during follow-up]","volume":"58","author":"Mora","year":"2005","journal-title":"Rev. Esp. Cardiol."},{"key":"ref_6","first-page":"281","article-title":"Evaluation of a spasmolytic cocktail to prevent radial artery spasm during coronary procedures","volume":"58","author":"Kiemeneij","year":"2003","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Lee, O.-H., Roh, J.W., Kim, Y., Son, N.-H., Cho, J.Y., Jang, D., Im, E., Cho, D.-K., and Choi, D. (2023). Comparison of spasmolytic regimen for prevention of radial artery spasm during the distal radial approach: A single-center, randomized study. Front. Cardiovasc. Med., 10.","DOI":"10.3389\/fcvm.2023.1007147"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1111\/joic.12000","article-title":"Incidence and predictors of radial artery spasm at the beginning of a transradial coronary procedure","volume":"26","author":"Gorgulu","year":"2013","journal-title":"J. Interv. Cardiol."},{"key":"ref_9","first-page":"843","article-title":"Incidence and predictors of radial artery spasm during transradial coronary angiography and intervention","volume":"123","author":"Jia","year":"2010","journal-title":"Chin. Med. J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"300","DOI":"10.5472\/marumj.1573178","article-title":"Incidence and risk factors of radial artery spasm during distal radial angiography","volume":"37","author":"Demirci","year":"2024","journal-title":"Marmara Med. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1177\/0003319713488931","article-title":"Anxiety score as a risk factor for radial artery vasospasm during radial interventions: A pilot study","volume":"65","author":"Ercan","year":"2014","journal-title":"Angiology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"367","DOI":"10.2174\/0115701611322882250127051550","article-title":"Music Therapy may Decrease Radial Artery Spasm Rates and Increase Satisfaction during Coronary Angiography","volume":"23","author":"Aslan","year":"2025","journal-title":"Curr. Vasc. Pharmacol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/10253890802046281","article-title":"Stress, depression and cardiovascular dysregulation: A review of neurobiological mechanisms and the integration of research from preclinical disease models","volume":"12","author":"Grippo","year":"2009","journal-title":"Stress"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2473","DOI":"10.1161\/01.CIR.102.20.2473","article-title":"Mental stress induces transient endothelial dysfunction in humans","volume":"102","author":"Ghiadoni","year":"2000","journal-title":"Circulation"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1016\/j.jpainsymman.2020.08.016","article-title":"Effect of Virtual Reality Therapy in Reducing Pain and Anxiety for Cancer-Related Medical Procedures: A Systematic Narrative Review","volume":"61","author":"Chow","year":"2021","journal-title":"J. Pain Symptom Manag."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.1093\/abm\/kaab016","article-title":"Using Virtual Technology for Fear of Medical Procedures: A Systematic Review of the Effectiveness of Virtual Reality-Based Interventions","volume":"55","author":"Brown","year":"2021","journal-title":"Ann. Behav. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e2340588","DOI":"10.1001\/jamanetworkopen.2023.40588","article-title":"Virtual Reality-Based Intervention to Reduce Preoperative Anxiety in Adults Undergoing Elective Surgery: A Randomized Clinical Trial","volume":"6","author":"Chiu","year":"2023","journal-title":"JAMA Netw. Open"},{"key":"ref_18","first-page":"312","article-title":"Virtual Reality Relaxation to Decrease Dental Anxiety: Immediate Effect Randomized Clinical Trial","volume":"5","author":"Lahti","year":"2020","journal-title":"JDR Clin. Transl. Res."},{"key":"ref_19","first-page":"63","article-title":"The effect of virtual reality distraction on anxiety level during dental treatment among anxious pediatric patients: A randomized clinical trial","volume":"47","author":"Bagher","year":"2023","journal-title":"J. Clin. Pediatr. Dent."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e13046","DOI":"10.1002\/jgh3.13046","article-title":"Use of virtual reality in patient education program to reduce anxiety in upper gastrointestinal endoscopy: A randomized controlled trial","volume":"8","author":"Siripongsaporn","year":"2024","journal-title":"JGH Open"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1097\/AJP.0b013e3181aaa909","article-title":"The effectiveness of virtual reality on reducing pain and anxiety in burn injury patients: A systematic review","volume":"25","author":"Morris","year":"2009","journal-title":"Clin. J. Pain"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"5353","DOI":"10.1002\/jcp.29422","article-title":"Virtual reality and music therapy as distraction interventions to alleviate anxiety and improve mood states in breast cancer patients during chemotherapy","volume":"235","author":"Chirico","year":"2020","journal-title":"J. Cell Physiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e1014","DOI":"10.4244\/EIJ-D-20-00269","article-title":"Virtual reality-assisted conscious sedation during transcatheter aortic valve implantation: A randomised pilot study","volume":"16","author":"Bruno","year":"2020","journal-title":"EuroIntervention"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e002628","DOI":"10.1136\/openhrt-2024-002628","article-title":"Virtual reality to reduce periprocedural anxiety during invasive coronary angiography: Rationale and design of the VR InCard trial","volume":"11","author":"Breunissen","year":"2024","journal-title":"Open Heart"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Albazee, E., Alrajehi, A., Alsahli, F.M., Alqemlas, A., Aldhaen, A., Alkandari, A., Alkandari, H., and Alkanderi, W. (2025). Virtual Reality Distraction for Reducing Pain and Anxiety During Percutaneous Cardiovascular Interventions: A Systematic Review and Meta-Analysis with Trial Sequential Analysis. Medicina, 61.","DOI":"10.3390\/medicina61060957"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.4244\/EIJV12I10A207","article-title":"Endothelial dysfunction and the occurrence of radial artery spasm during transradial coronary procedures: The ACRA-Spasm study","volume":"12","author":"Janssens","year":"2016","journal-title":"EuroIntervention"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"7932114","DOI":"10.1155\/2022\/7932114","article-title":"Comparison between the Right and Left Distal Radial Access for Patients Undergoing Coronary Procedures: A Propensity Score Matching Analysis","volume":"2022","author":"Rivera","year":"2022","journal-title":"J. Interv. Cardiol."},{"key":"ref_28","first-page":"356","article-title":"Frequency and Predictors of Radial Artery Spasm During Coronary Angiography\/Percutaneous Coronary Intervention","volume":"32","author":"Khan","year":"2020","journal-title":"J. Ayub Med. Coll. Abbottabad"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"360","DOI":"10.5603\/KP.a2016.0184","article-title":"Can radial artery pulse grading predict radial artery spasm during transradial approach?","volume":"75","author":"Zencirci","year":"2017","journal-title":"Kardiol. Pol."},{"key":"ref_30","first-page":"90","article-title":"Resistant radial artery spasm during coronary angiography via radial approach responded to local warm compress","volume":"10","author":"Amasyali","year":"2010","journal-title":"Anadolu Kardiyol. Derg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1016\/j.repc.2016.11.008","article-title":"Manual heating of the radial artery (Balbay maneuver) to facilitate radial puncture prior to transradial coronary catheterization","volume":"36","author":"Yayla","year":"2017","journal-title":"Rev. Port. Cardiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/j.carrev.2013.08.009","article-title":"The effects of intra-arterial vasodilators on radial artery size and spasm: Implications for contemporary use of trans-radial access for coronary angiography and percutaneous coronary intervention","volume":"14","author":"Boyer","year":"2013","journal-title":"Cardiovasc. Revascularization Med."},{"key":"ref_33","first-page":"122","article-title":"Nitroglycerin plus diltiazem versus nitroglycerin alone for spasm prophylaxis with transradial approach","volume":"24","author":"Dharma","year":"2012","journal-title":"J. Invasive Cardiol."},{"key":"ref_34","first-page":"766","article-title":"How to limit radial artery spasm during percutaneous coronary interventions: The spasmolytic agents to avoid spasm during transradial percutaneous coronary interventions (SPASM3) study","volume":"84","author":"Rosencher","year":"2014","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.jcin.2012.11.005","article-title":"Moderate procedural sedation and opioid analgesia during transradial coronary interventions to prevent spasm: A prospective randomized study","volume":"6","author":"Deftereos","year":"2013","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Birgy, C., Trimaille, A., Messas, N., Ristorto, J., Kayali, A., Marchandot, B., Cardi, T., Hess, S., Kibler, M., and Jesel, L. (2020). Impact of Opioid Analgesia and Inhalation Sedation Kalinox on Pain and Radial Artery Spasm during Transradial Coronary Angiography. J. Clin. Med., 9.","DOI":"10.3390\/jcm9092747"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1007\/s00059-015-4373-5","article-title":"Procedural sedation during transradial coronary angiography to prevent spasm","volume":"41","author":"Astarcioglu","year":"2016","journal-title":"Herz"},{"key":"ref_38","unstructured":"Spielberger, C.D., Gorsuch, R.L., and Lushene, R.E. (1970). Manual for the State-Trait Anxiety Inventory (STAI), Consulting Psychologists Press."},{"key":"ref_39","unstructured":"\u00d6ner, N., and Le Compte, A. (1983). Durumluk\u2013S\u00fcrekli Kayg\u0131 Envanteri el Kitab\u0131, Bo\u011fazi\u00e7i \u00dcniversitesi Yay\u0131nlar\u0131."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/0304-3959(83)90126-4","article-title":"The validation of visual analogue scales as ratio scale measures for chronic and experimental pain","volume":"17","author":"Price","year":"1983","journal-title":"Pain"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1344","DOI":"10.1213\/ANE.0000000000004165","article-title":"Systematic Review and Meta-analysis of Virtual Reality in Pediatrics: Effects on Pain and Anxiety","volume":"129","author":"Eijlers","year":"2019","journal-title":"Anesth. Analg."},{"key":"ref_42","first-page":"e234","article-title":"Virtual reality for management of pain and anxiety in hospitalized patients","volume":"19","author":"Tashjian","year":"2017","journal-title":"J. Med. Internet Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e177","DOI":"10.1016\/j.pmn.2023.11.009","article-title":"Effects of Virtual Reality on Pain, Anxiety, Patient Satisfaction in Coronary Angiography: A Randomized Trial","volume":"25","author":"Turan","year":"2024","journal-title":"Pain Manag. Nurs."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.carrev.2011.11.003","article-title":"Radial artery spasm during transradial cardiac catheterization and percutaneous coronary intervention: Incidence, predisposing factors, prevention, and management","volume":"13","author":"Ho","year":"2012","journal-title":"Cardiovasc. Revascularization Med."},{"key":"ref_45","first-page":"1247","article-title":"The Role of Oral Verapamil in Preventing Radial Spasm During Transradial Angiography","volume":"106","author":"Sural","year":"2025","journal-title":"Catheter. Cardiovasc. Interv."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/7227\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T12:09:08Z","timestamp":1789646948000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/7227"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,17]]},"references-count":45,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15187227"],"URL":"https:\/\/doi.org\/10.3390\/jcm15187227","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,17]]}}}