What is the recommended management of radial artery spasm during transradial PCI?

• A. Intra-arterial vasodilators (nitroglycerin, calcium channel blocker), ensure adequate analgesia, and switch access if spasm persists.
• B. Increase systemic anticoagulation alone.
• C. Immediate removal of catheter with no vasodilators.
• D. Thrombosis management with thrombolytics.

Answer: (A)

Radial artery spasm is best addressed by reversing the vasoconstriction locally and reducing sympathetic drive. The recommended approach is to administer intra-arterial vasodilators such as nitroglycerin and a calcium-channel blocker (for example, verapamil or diltiazem), ensure adequate analgesia to lessen pain-induced sympathetic tone, and switch access if the spasm persists.

This targeted approach directly relaxes the smooth muscle of the radial artery, expanding the lumen and allowing catheter manipulation to continue. Analgesia helps calm the patient and further decreases reflex vasoconstriction. If spasm does not resolve with these measures, moving to another access site preserves the conduit for the procedure and avoids ongoing arterial injury. Systemic anticoagulation alone does not relieve spasm, and thrombosis-directed therapy is not indicated unless there is true thrombus, so the vasodilator- and analgesia-centered strategy is the correct first step. Removing the catheter without vasodilators can worsen spasm, and thrombolytics address a different problem than vasospasm.