Chapter 26: Radial Artery Spasm

Radial artery (RA) access provides multiple advantages over other access options for catheterization procedures as described earlier in this book. These advantages are offset by a relatively frequent occurrence of radial artery spasm (RAS), which can turn this elegant, patient-friendly procedure into a painful, tedious, and rarely impossible procedure.

Defining Spasm

A well-accepted, standardized definition of RAS does not exist in absence of any objective parameter of RAS. The commonly described subjective clinical signs and symptoms determining RAS include the following:

1. Wrist or forearm pain in response to sheath or catheter insertion or withdrawal

2. Pain in response to catheter manipulation

3. Difficult catheter manipulation with resistance and tactile feel of a “trapped” catheter

4. Persistent forearm pain in absence of catheter manipulation or after sheath withdrawal

5. Catheter or sheath entrapments and inability to withdraw

Kintur Sanghvi, MD, FACC, FSCAI