{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,13]],"date-time":"2026-11-13T10:19:54Z","timestamp":1794565194784,"version":"4.9.1"},"reference-count":22,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T00:00:00Z","timestamp":1748476800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Victor Babe\u015f University of Medicine and Pharmacy Timi\u015foara"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Radial artery spasm (RAS) is a frequent complication during invasive angiography using the transradial approach, leading to patient discomfort and procedural challenges. While intra-arterial nitroglycerine (NTG) effectively reduces RAS after sheath insertion, preprocedural prevention strategies are limited. This study evaluates the efficacy of topical NTG in improving radial artery puncture success and reducing RAS incidence. Materials and Methods: In a randomized, double-blind single-center study 100 patients undergoing angiography were pretreated with either topical NTG or placebo. Outcomes assessed included RAS incidence, radial artery puncture success, number of attempts, procedural duration, patient discomfort, and complications. RAS was evaluated angiographically and clinically, with additional subgroup analyses for diabetic and smoking patients. Results: Topical NTG significantly reduced RAS incidence (53.2% vs. 73.6%; p = 0.0349) and increased radial puncture success on the first attempt (89.4% vs. 77.4%; p = 0.0488). Diabetic patients particularly benefited from NTG application, with lower RAS rates (36.4% vs. 76.2%; p = 0.0296). No significant differences were observed in procedural duration, patient discomfort, or complication rates between groups. The placebo group demonstrated a higher incidence of diffuse RAS (p = 0.0109). Conclusions: Preprocedural topical NTG application is a safe, non-invasive intervention that improves radial artery access success and reduces RAS, especially in high-risk subgroups such as diabetics. These findings support its potential as a procedural optimization tool in cardiovascular interventions, particularly in patients with heart failure, who often require repeated and reliable vascular access.<\/jats:p>","DOI":"10.3390\/medicina61061016","type":"journal-article","created":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T07:46:26Z","timestamp":1748504786000},"page":"1016","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Topical Nitroglycerin for Radial Access Optimization: Supporting Vascular Access in Patients at Risk for Acute Heart Failure"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-3377-1465","authenticated-orcid":false,"given":"Adrian Sebastian","family":"Zus","sequence":"first","affiliation":[{"name":"Cardiology Department, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania"},{"name":"Research Center of the Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simina","family":"Cri\u0219an","sequence":"additional","affiliation":[{"name":"Cardiology Department, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania"},{"name":"Research Center of the Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Luca","sequence":"additional","affiliation":[{"name":"Cardiology Department, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania"},{"name":"Research Center of the Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1298-9090","authenticated-orcid":false,"given":"Daniel","family":"Ni\u0219ulescu","sequence":"additional","affiliation":[{"name":"Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania"},{"name":"Research Center of the Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania"},{"name":"Department of Histology, Faculty of Medicine, Vasile Goldis Western University of Arad, 310025 Arad, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihaela","family":"Valcovici","sequence":"additional","affiliation":[{"name":"Cardiology Department, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania"},{"name":"Research Center of the Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oana","family":"P\u0103tru","sequence":"additional","affiliation":[{"name":"Cardiology Department, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Research Center of the Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihai-Andrei","family":"Laz\u0103r","sequence":"additional","affiliation":[{"name":"Cardiology Department, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania"},{"name":"Research Center of the Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"V\u0103c\u0103rescu","sequence":"additional","affiliation":[{"name":"Cardiology Department, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania"},{"name":"Research Center of the Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Gai\u021b\u0103","sequence":"additional","affiliation":[{"name":"Cardiology Department, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania"},{"name":"Research Center of the Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constantin-Tudor","family":"Luca","sequence":"additional","affiliation":[{"name":"Cardiology Department, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania"},{"name":"Research Center of the Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1002\/clc.22745","article-title":"Heart Failure in Patients Admitted for Acute Coronary Syndromes: A Report from a Large National Registry","volume":"40","author":"Jeger","year":"2017","journal-title":"Clin. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1002\/ehf2.13716","article-title":"Coronary Angiography in Patients with Acute Heart Failure: From the KCHF Registry","volume":"9","author":"Seko","year":"2022","journal-title":"ESC Heart Fail."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3415","DOI":"10.1093\/eurheartj\/ehae177","article-title":"2024 ESC Guidelines for the Management of Chronic Coronary Syndromes","volume":"45","author":"Vrints","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Bajraktari, G., Rexhaj, Z., Elezi, S., Zhubi-Bakija, F., Bajraktari, A., Byty\u00e7i, I., Batalli, A., and Henein, M.Y. (2021). Radial Access for Coronary Angiography Carries Fewer Complications Compared with Femoral Access: A Meta-Analysis of Randomized Controlled Trials. J. Clin. Med., 10.","DOI":"10.3390\/jcm10102163"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e208","DOI":"10.1097\/MJT.0000000000000914","article-title":"Current Perspectives in Facilitated Angioplasty","volume":"26","author":"Petrescu","year":"2019","journal-title":"Am. J. Ther."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1016\/S0022-5223(98)70414-3","article-title":"Characteristics of Adrenoceptors in the Human Radial Artery: Clinical Implications","volume":"115","author":"He","year":"1998","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"26","DOI":"10.4330\/wjc.v12.i1.26","article-title":"Radial Artery Access Site Complications during Cardiac Procedures, Clinical Implications and Potential Solutions: The Role of Nitric Oxide","volume":"12","author":"Coghill","year":"2020","journal-title":"World J. Cardiol."},{"key":"ref_9","first-page":"53","article-title":"Radial Artery Spasms\u2014Angiographic Morphology, Riskfactors and Management","volume":"20","author":"Roczniak","year":"2024","journal-title":"Adv. Interv. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.carrev.2021.12.007","article-title":"Radial Artery Access Complications: Prevention, Diagnosis and Management","volume":"40","author":"Roy","year":"2022","journal-title":"Cardiovasc. Revascularization Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1159\/000089246","article-title":"A Simple and Effective Regimen for Prevention of Radial Artery Spasm during Coronary Catheterization","volume":"105","author":"Chen","year":"2006","journal-title":"Cardiology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1002\/ccd.10445","article-title":"Evaluation of a Spasmolytic Cocktail to Prevent Radial Artery Spasm during Coronary Procedures","volume":"58","author":"Kiemeneij","year":"2003","journal-title":"Cathet Cardio Interv."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"31","DOI":"10.4103\/2229-516X.81977","article-title":"Serum Nitric Oxide Status in Patients with Type 2 Diabetes Mellitus in Sikkim","volume":"1","author":"Ghosh","year":"2011","journal-title":"Int. J. Appl. Basic. Med. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"A16146","DOI":"10.1161\/circ.142.suppl_3.16146","article-title":"Topical Nitroglycerine Reduces Radial Access Site Failure and Femoral Crossover\u2014Topical Nitroglycerine to Prevent Radial Artery Spasm (TNTRASP) Study","volume":"142","author":"Gopalakrishnan","year":"2020","journal-title":"Circulation"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1007\/s00424-023-02805-z","article-title":"Tobacco Smoking and Vascular Biology and Function: Evidence from Human Studies","volume":"475","author":"Hahad","year":"2023","journal-title":"Pflug. Arch."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1016\/S0140-6736(18)31714-8","article-title":"Radial versus Femoral Access and Bivalirudin versus Unfractionated Heparin in Invasively Managed Patients with Acute Coronary Syndrome (MATRIX): Final 1-Year Results of a Multicentre, Randomised Controlled Trial","volume":"392","author":"Valgimigli","year":"2018","journal-title":"Lancet"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"305","DOI":"10.21037\/cdt.2017.03.14","article-title":"Radial Artery Occlusion after Transradial Coronary Catheterization","volume":"7","author":"Avdikos","year":"2017","journal-title":"Cardiovasc. Diagn. Ther."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e9","DOI":"10.1016\/j.jcrc.2012.04.019","article-title":"Topical Nitroglycerin and Lidocaine Locally Vasodilate the Radial Artery without Affecting Systemic Blood Pressure: A Dose-Finding Phase I Study","volume":"27","author":"Majure","year":"2012","journal-title":"J. Crit. Care"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2575","DOI":"10.1016\/j.ijcard.2013.03.048","article-title":"Topical Nitroglycerin and Lidocaine to Dilate the Radial Artery Prior to Transradial Cardiac Catheterization: A Randomized, Placebo-Controlled, Double-Blind Clinical Trial","volume":"168","author":"Beyer","year":"2013","journal-title":"Int. J. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"100689","DOI":"10.1016\/j.ijcha.2020.100689","article-title":"Novel Combined Topical Gel of Lidocaine\u2013Verapamil\u2013Nitroglycerin Can Dilate the Radial Artery and Reduce Radial Pain during Trans-Radial Angioplasty","volume":"32","author":"MikailiMirak","year":"2021","journal-title":"IJC Heart Vasc."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1016\/j.jcin.2022.02.026","article-title":"Randomized Clinical Trial on Prevention of Radial Occlusion After Transradial Access Using Nitroglycerin","volume":"15","author":"Dangas","year":"2022","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"738","DOI":"10.11124\/JBISRIR-2017-003358","article-title":"The Effect of Topical Medications on Radial Artery Spasm in Patients Undergoing Transradial Coronary Procedures: A Systematic Review","volume":"16","author":"Curtis","year":"2018","journal-title":"JBI Database Syst. Rev. Implement. Rep."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/6\/1016\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:43:04Z","timestamp":1760031784000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/6\/1016"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,29]]},"references-count":22,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["medicina61061016"],"URL":"https:\/\/doi.org\/10.3390\/medicina61061016","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,29]]}}}