Author + information
- Alexis S. Antonopoulos,
- George Latsios,
- Evangelos Oikonomou,
- Georgia Vogiatzi,
- Angelos Papanikolaou,
- Gerasimos Siasos,
- Eleftherios Tsiamis,
- Konstantinos Toutouzas and
- Dimitris Tousoulis
Background: Evidence suggests that transradial access (TRA) coronary catheterization leads to endothelial dysfunction of the catheterised radial artery, which has raised concerns over its future use as an arterial graft. We designed a clinical study and systematically reviewed published literature to investigate the magnitude and the reversibility of this effect.
Methods: In Part A we studied 18 consecutive patients (mean age 65±8 years) undergoing TRA diagnostic coronary catheterization. Endothelial function was assessed by the flow- (FMD) and nitrate mediated dilatation (NMD) of both the ipsilateral (catheterised) and contralateral (control) brachial artery at baseline and at 6h post angiography. In Part B we searched PubMed from inception to May 2016 for published clinical studies assessing radial artery FMD/NMD before and after TRA coronary catheterization; a total of 7 published studies (n=275 subjects) were identified that assessed the acute effects of TRA on radial endothelial function as well as 5 studies that assessed radial endothelial function at least 30 days after TRA (n=164 subjects).
Results: In Part A, TRA induced a rapid decline in the brachial FMD of access arm at 6h compared to baseline (1.47±1.71% vs. 4.00±2.52%, p=0.003) while it did not affect the FMD of the control arm (p=NS). In Part B, a significant reduction in endothelial function was observed acutely post-TRA catheterization [weighted MD for FMD: −4.22% (95%CI: −5.36% to −3.07%), p<0.001 and for NMD: −4.77% (95%CI: −5.76 to −3.78), p<0.001]. In those studies assessing recovery of vascular function at least 30 days post catheterization, a persistent impairment in FMD was documented [pooled MD: −0.88% (95%CI: −1.76% to 0.00%), p=0.05], while NMD was not significantly different compared to baseline (weighted MD: 0.03% (95%CI: −1.61% to 1.68%) p=NS].
Conclusions: TRA induces an acute reduction in both FMD and NMD responses of catheterised artery. After a month post catheterization, vascular smooth muscle function recovers, while there is a borderline but still significant impairment of endothelial function, which may be important for the future use of catheterised radial artery as a graft.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Vascular Access and Hemostasis Issues
Abstract Category: 26. Interventional Cardiology: Vascular Access and Complications
Presentation Number: 1192-125
- 2017 American College of Cardiology Foundation