What is radial artery spasm and how is it treated?

• A. Sudden constriction of the radial artery during transradial access; treated with vasodilators (nitroglycerin, calcium channel blockers), sedation, and sometimes switching access
• B. Bleeding at access site
• C. Allergic reaction to contrast
• D. Aortic dissection

Answer: (A)

Radial artery spasm is an abrupt constriction of the radial artery that can occur during transradial access. It causes sudden forearm pain and makes it hard to advance or manipulate the guidewire or catheter, sometimes with reduced distal perfusion. The artery tightens in response to irritation, cold, and increased sympathetic tone from the procedure.

The treatment aims to relax the artery and relieve the spasm. Vasodilators are key: nitroglycerin relaxes smooth muscle, and calcium channel blockers such as verapamil or diltiazem help prevent and reduce spasm. Providing sedation or analgesia helps lower sympathetic drive that sustains the contraction. If the spasm persists or severely impedes the procedure, switching to another access site, such as the contralateral radial or femoral artery, is commonly done to complete the intervention safely.

Bleeding at the access site, an allergic reaction to contrast, and aortic dissection are different complications with distinct clinical signs and management, not the spasm described here.