- ICH GCP
- Yhdysvaltain kliinisten tutkimusten rekisteri
- Kliininen tutkimus NCT03304496
Subcutaneous Nitroglycerin to Facilitate Trans-radial Access. (NITRAD-Sub)
Subcutaneous Administration of Nitroglycerin to Facilitate Trans-radial Access in Coronary Procedures: a Randomized Clinical Trial (NITRAD-Sub Study).
Tutkimuksen yleiskatsaus
Tila
Ehdot
Interventio / Hoito
Yksityiskohtainen kuvaus
Unlike femoral access, the trans-radial approach to coronary angiography requires a greater learning curve for the inexperienced interventionist, and demands a greater technical challenge than the femoral approach, which leads to a high incidence of failures and complications, mainly in the initial stages of their formation. Some explanations for procedural failure include inability for radial artery puncture, vessel tortuosity, and radial spasm. Radial spasm has been reported from 5 to 30% in experienced centers, with a decrease to 2.5% when associated with the administration of nitrate added to local anesthesia. Although radial spasm is infrequent and usually occurs once the artery is cannulated or during manipulation of the catheters, it can sometimes occur before cannulation due to multiple unsuccessful attempts to cannulate the artery, which can also produce pain in the patient.
The investigators will conduct an experimental, placebo-controlled, longitudinal, prospective, double-blind, parallel arm clinical trial. Patients will be randomized to receive 1:1 an intervention or placebo. Intervention group will receive a subcutaneous "cocktail" with 0.5 ml of 500 mcg of nitroglycerin + 1 ml of 2% simple lidocaine. Placebo group will receive a subcutaneous injection with 0.5 ml of 0.9% saline solution + 1 ml of 2% simple lidocaine.
The investigators hypothesize that the maneuver (subcutaneous infiltration of local anesthetic together with nitroglycerin) will facilitate radial access in terms of fewer punctures until the insertion of the arterial introducer, shorter access time, lower incidence of radial spasm, and lower crossover rate to femoral access, compared with placebo. In terms of safety, the investigators do not believe that the maneuver represents a risk to the patient in terms of incidence of hypotension or headache. In fact, the investigators believe that the maneuver will provide less pain at the site of puncture referred by the patient due to the less number of unsuccessful punctures.
For the calculation of the required sample, since the incidence of our primary end-point of a compound of crossover to femoral access and/or access site-related vascular complications has not been reported so far, the sample will be calculated with the rate of events obtained in our center at 6 months of recruiting patients. For this calculation, the proportional difference formula with an alpha value of 0,05 and a beta value of 0,20 will be used to have a statistical power of 80%. The investigators estimate that 1,500 patients will be required in a 11-month period.
Opintotyyppi
Ilmoittautuminen (Odotettu)
Vaihe
- Vaihe 4
Yhteystiedot ja paikat
Opiskelupaikat
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Tlalpan
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Mexico City, Tlalpan, Meksiko, 04480
- Rekrytointi
- Instituto Nacional de Cardiologia Ignacio Chavez
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Ottaa yhteyttä:
- Julio Sandoval Zarate, MD
- Sähköposti: julio.sandoval@cardiologia.org.mx
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Osallistumiskriteerit
Kelpoisuusvaatimukset
Opintokelpoiset iät
Hyväksyy terveitä vapaaehtoisia
Sukupuolet, jotka voivat opiskella
Kuvaus
Inclusion Criteria:
- Men and women older than 18 years, scheduled consecutively to perform a coronary procedure in the department of hemodynamics of the National Institute of Cardiology "Ignacio Chavez".
- Patients may have any of the following indications for cardiac catheterization: Thoracic pain under study. Stable chronic coronary disease. Acute myocardial infarction with ST segment elevation, not perfused (without timely reperfusion therapy) with less than 4 weeks of evolution. Acute myocardial infarction with ST-segment elevation, successful thrombolytic therapy, which will undergo drug-invasive therapy. Acute myocardial infarction without ST segment elevation. Unstable angina. Any acute coronary syndrome, to intervene non-infarct-related artery. Disease of any heart valve. Myocarditis or pericarditis. Dilated cardiomyopathy. Patients in renal or cardiac transplantation protocol for any etiology. Congenital heart disease that requires knowing the coronary anatomy prior to surgical correction.
- The planned procedure can be any of the following: For diagnostic purposes (coronary angiography only, left catheterization, left and right catheterization). For therapeutic purposes: percutaneous coronary intervention (PCI), with or without stent placement.
- A priori access must be right or left radial artery.
- Radial arterial pulse may be present or absent by palpation.
- Modified Allen or Barbeau test should be positive (presence of collateral palmar flow).
Exclusion Criteria:
- Pregnant.
- Not have informed consent for the present clinical trial, or do not fully understand the meaning of informed consent.
- With acute myocardial infarction with ST segment elevation in the first 12 hours from the onset of symptoms.
- With any acute coronary syndrome complicated with acute pulmonary edema, cardiogenic shock and / or malignant ventricular arrhythmias.
- In which a cardiac catheterization is planned a priori to be performed via femoral, brachial or ulnar.
- Patients in whom first attempt of arterial puncture is performed by 2nd year interventional cardiology fellow or by physician in charge.
- Participating in another clinical trial.
- Be allergic or have contraindications to nitroglycerin or other nitrates.
- Any phosphodiesterase 5 inhibitor (sildenafil, tadalafil, avanafil, vardenafil) has been taken within 72 hours prior to the study.
Opintosuunnitelma
Miten tutkimus on suunniteltu?
Suunnittelun yksityiskohdat
- Ensisijainen käyttötarkoitus: Tukevaa hoitoa
- Jako: Satunnaistettu
- Inventiomalli: Rinnakkaistehtävä
- Naamiointi: Kolminkertaistaa
Aseet ja interventiot
Osallistujaryhmä / Arm |
Interventio / Hoito |
---|---|
Kokeellinen: Nitroglycerin
The intervention group will receive a subcutaneous "cocktail" with 0,5 ml of 500 mcg of nitroglycerin + 1 ml of 2% simple lidocaine.
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Previously described.
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Placebo Comparator: Control
The placebo group will receive a subcutaneous injection with 0,5 ml of 0,9% saline solution + 1 ml of 2% simple lidocaine.
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Previously described.
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Mitä tutkimuksessa mitataan?
Ensisijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
---|---|---|
Compound of crossover to femoral access and/or access site-related vascular complications.
Aikaikkuna: Within 72 hours or at hospital discharge (whichever occurs first).
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Crossover to femoral access: number of cases in which the procedure could not be completed via radial artery and access via femoral artery was changed.
Access site-related vascular complications: hematoma requiring intervention as an additional compression bandage, radial perforation / dissection, hemorrhage requiring transfusion, compartment syndrome, arteriovenous fistula, pseudoaneurysm, or any complication requiring surgical intervention.
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Within 72 hours or at hospital discharge (whichever occurs first).
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Toissijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
---|---|---|
Number of attempts to cannulate the radial artery (punctures).
Aikaikkuna: Through study completion, an average of 1 year.
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Number of times the needle is inserted through the skin with the intention of puncturing the radial artery.
This outcome measure will be assessed by interventional cardiology fellow who applies the maneuver and attempt to cannulate the artery.
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Through study completion, an average of 1 year.
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Time until obtaining the radial access.
Aikaikkuna: Through study completion, an average of 1 year.
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Counted from the first attempt to puncture the radial artery, from the needle through the skin to the successful insertion of the introducer into the radial artery with adequate blood return.
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Through study completion, an average of 1 year.
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Improvement in radial pulse strength.
Aikaikkuna: Through study completion, an average of 1 year.
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The interventional cardiologist fellow who will apply the maneuver, will assess the strength of the radial pulse before the administration of the maneuver and at least 1 minute after, and will record the change in pulse strength.
Pulse Score: 0 - No palpable pulse. 1 - Weak pulse. 2 - Pulse of normal intensity.
3 - Very intense pulse.
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Through study completion, an average of 1 year.
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Loss of radial artery flow (radial artery occlusion) at 30 days.
Aikaikkuna: At 30 days.
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The maximum longitudinal and transverse diameter of the radial artery and the maximum arterial flow velocity will be measured, with the transducer placed 1 cm proximal to the styloid process using ultrasound doppler with a vascular transducer.
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At 30 days.
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Pain in the cannulated extremity.
Aikaikkuna: Through study completion, an average of 1 year.
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It will be evaluated with a visual-analogue subjective pain scale from 1 to 10 referred by the patient.
Pain will be assessed at the time of introducing the radial introducer.
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Through study completion, an average of 1 year.
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Radial spasm.
Aikaikkuna: During coronary procedure.
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It will be referred to as radial spasm if the patient reports pain or discomfort of any intensity at the cannulated end, at the time of manipulating, advancing and / or withdrawing any catheter through the arterial introducer.
Angiographic confirmation of spasm may or may not be done.
Additional intra-arterial vasodilators, or additional IV analgesics, may or may not be administered at the discretion of the operator.
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During coronary procedure.
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Headache.
Aikaikkuna: During coronary procedure.
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Referred by the patient during any time of the procedure in the hemodynamic laboratory.
It will be recorded on a subjective-to-analogue subjective pain scale from 1 to 10.
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During coronary procedure.
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Hypotension.
Aikaikkuna: In the following 10 minutes after administration of the maneuver.
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Systolic blood pressure lower than 90 mmHg in the following 10 minutes after the maneuver, not related to the manipulation of a coronary artery with any device.
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In the following 10 minutes after administration of the maneuver.
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Yhteistyökumppanit ja tutkijat
Tutkijat
- Opintojohtaja: Marco Antonio Peña Duque, MD, Director of Department of Interventional Cardiology, National Institute of Cardiology, Mexico City, Mexico.
Opintojen ennätyspäivät
Opi tärkeimmät päivämäärät
Opiskelun aloitus (Todellinen)
Ensisijainen valmistuminen (Odotettu)
Opintojen valmistuminen (Odotettu)
Opintoihin ilmoittautumispäivät
Ensimmäinen lähetetty
Ensimmäinen toimitettu, joka täytti QC-kriteerit
Ensimmäinen Lähetetty (Todellinen)
Tutkimustietojen päivitykset
Viimeisin päivitys julkaistu (Todellinen)
Viimeisin lähetetty päivitys, joka täytti QC-kriteerit
Viimeksi vahvistettu
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