I have heard from other cardiologists that use of the radial approach in younger women should be avoided because of a higher incidence of spasm. Are there data on this?
Several data sets support the clinical impression that spasm is more common in younger women. A very recent single-center registry examining the clinical predictors was published by Chinese investigators (Jia et al, Chinese Med Journ 2010, 123 (7) 843 – 47). The mean age of spasm patients was nearly 10 years younger than “non-spasm” patients. Analysis revealed that female sex, small radial artery, diabetes, and failed first puncture all increased the risk of symptomatic radial artery spasm. I think that experienced operators do not avoid these cases, but go into them knowing that techniques to decrease spasm should be high on their radar. These include good sedation, vasodilators, small sheath and catheters, and limited catheter use and exchanges. With these techniques, procedural failure from spasm can be limited greatly, although of course never completely eliminated.
