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Transradial Cardiac Catheterization Medication

  • Author: David H Adler, MD, FACC; Chief Editor: Eric H Yang, MD  more...
Updated: Jan 24, 2014

Medication Summary

The goals of pharmacotherapy are to minimize pain, to reduce morbidity, and to prevent complications.


Local Anesthetics, Amides

Class Summary

Local anesthetics are used for local pain relief.

Lidocaine (Xylocaine)


Lidocaine 1%-2% may be used. Lidocaine is an amide local anesthetic used in 1%-2% concentration. The 1% preparation contains 10 mg of lidocaine for each 1 mL of solution; the 2% preparation contains 20 mg of lidocaine for each 1 mL of solution. Lidocaine inhibits depolarization of type C sensory neurons by blocking sodium channels.

Bupivacaine (Marcaine)


Bupivacaine decreases permeability to sodium ions in neuronal membranes. This results in the inhibition of depolarization, blocking the transmission of nerve impulses.


Calcium Channel Blockers

Class Summary

Calcium channel blockers are used to prevent radial artery spasm.

Diltiazem (Cardizem, Dilacor XR, Diltzac, Matzim LA)


During depolarization, diltiazem inhibits calcium ions from entering slow channels and voltage-sensitive areas of vascular smooth muscle and myocardium.

Verapamil (Verelan, Calan)


Verapamil inhibits calcium ions from entering slow channels and voltage-sensitive areas of vascular smooth muscle and myocardium.



Class Summary

Vasodilators dilate the mesenteric arterial system. They thereby reverse reactive arterial vasospasms.

Nitroglycerin (Nitro-Dur, Nitro-Bid, Nitrolingual, Nitrostat)


Nitroglycerin produces a vasodilator effect on the peripheral veins and arteries.


Anticoagulants, Hematologic



Heparin may be used if thrombocytopenia is not present. Heparin augments activity of antithrombin III and prevents conversion of fibrinogen to fibrin. It does not actively lyse but is able to inhibit further thrombogenesis. It prevents recurrence of a clot after spontaneous fibrinolysis.

Bivalirudin (Angiomax)


Bivalirudin inhibits coagulant effects by preventing thrombin-mediated cleavage of fibrinogen to fibrin.

Contributor Information and Disclosures

David H Adler, MD, FACC Assistant Professor of Medicine, Eastern Virginia Medical School; Cardiologist, Cardiovascular Associates, Ltd

David H Adler, MD, FACC is a member of the following medical societies: American College of Cardiology, American Heart Association

Disclosure: Nothing to disclose.

Chief Editor

Eric H Yang, MD Associate Professor of Medicine, Director of Cardiac Catherization Laboratory and Interventional Cardiology, Mayo Clinic Arizona

Eric H Yang, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

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Radial Artery Loop: Radial loops are a common arterial anomaly. Most radial loops can be traversed with a guidewire and an sheath advanced beyond the loop in order to proceed with angiography. The radial loop pictured is an extreme example. A decision was made to use a different arterial access site in this case.
Radial Artery Spasm (1 of 3): Contrast injection shows severe spasm in the radial artery.
Radial Artery Spasm (2 of 3): After intra-arterial injection of nitroglycerin and verapamil, the radial artery spasm is relieved.
Radial Artery Spasm (3 of 3): After relief of spasm with vasodilators, an introducer sheath has been easily advanced into the radial artery.
Tortuous Subclavian Artery (1 of 2): Tortuosity of the subclavian artery can make catheter manipulation difficult.
Tortuous Subclavian Artery (2 of 2): Successful coronary angiography was performed in this case despite the severe tortuosity of the subclavian artery.
Radial Loop (1 of 3): This radial artery loop was encountered after placement of an an access sheath in the radial artery at the wrist. This common arterial anamoly presents a challenge to performing transradial catheterization, but can usually be traversed using a guidewire.
Radial Loop (2 of 3): A 0.014 inch guidewire has been advanced across the radial loop. This will allow advancement of a catheter above the loop.
Radial Loop (3 of 3): A catheter has been advanced beyond the radial loop to the ascending aorta. Successful coronary angiography was performed.
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