Comparative study of nicorandil and a spasmolytic cocktail in preventing radial artery spasm during transradial coronary angiography

Background: Radial artery spasm is one of the most common complications during coronary angiography via the transradial approach, causing patient discomfort or sometimes interrupting the procedure. This study was designed to compare the spasmolytic effect between nicorandil and a cocktail during transradial coronary angiography. Methods: A randomized study to compare 4 mg of nicorandil and a coctail (mixture of normal saline, 200 μg of verapamil) was performed in 150 patients. We examined vasospasms of the radial artery that were expressed as stenosis of the radial artery vessel diameter after the procedure. Result: The reductions of systolic and diastolic blood pressures showed no significant differences between the two groups (15.4 ± 11.5/7.7 ± 7.8 mmHg for nicorandil and 16.3 ± 13.4/6.2 mmHg for cocktail). Both agents induced a significant radial artery vasodilation after transradial administration at proximal and mid segments (P < 0.001 for all). Nicorandil showed a significant increase of the mean change of the radial artery diameter compared to the cocktail at mid-segment (0.32 ± 0.23 mm for nicorandil and 0.24 ± 0.15 mm for a cocktail, P < 0.05). There was no statistically significant difference between the two groups in radial artery spasm (50.7% vs. 52.0% in nicorandil and a cocktail, respectively) after catheterization. Conclusion: Nicorandil with vasodilator effects by a dual mechnism was effective as the cocktail in preventing radial artery spasm during transradial coronary angiography.