Author + information
- Santiago Camacho Freire1,
- Javier Leon Jimenez1,
- Jessica Roa-Garrido2,
- Rosa Maria Cardenal Piris1 and
- Jose Diaz1
Transradial coronary intervention (TRI) introduces a trauma to the radial artery (RA), possibly influencing quality as a bypass conduit if subsequently used. We sought to determine the acute and chronic effects of TRI on the RA by optical coherence tomography (OCT).
After TRI completion, 35 RAs in 35 patients were examined. The sheath was pulled back 2 cm distal to the puncture site, and OCT was done. The following data were colected: mean diameter, luminal area, area of intima and media layer, intima and media thickening, ITI (intima/media area ratio), IMR (max intimal/max media thickening), intimal injury, dissection, thrombi, plaques, vessel stenosis, spasm. The acute injuries and intimal thickening were compared between first-TRI RAs (group 1) and repeat-TRI (group 2).
Mean age was 60±12 years, 85% male, 49% smokers, 60% hypertensive, 34% dyslipemic, 17% previous IHD and 46% had previous radial catheterization. 100% right radial 6F. Catheterization was diagnostic in 60% and 40% therapeutic. Mean cannulated time was 39±19 min. The mean number of diagnostic catheters used was 1.8±0.7/1.2±0.4 therapeutics. Terumo hydrophilic wire was required in 3%, sheathless catheter in 6%. On the EVO pain scale the mean was 4.3±1.8 points. Midazolam/fentanyl was given in 25% of cases. Intimal tears were observed in 18% RAs and were more frequent in the proximal than in the distal RA. Medial dissections were uncommon (6.5% RAs). The frequency of acute injury was similar between groups. Intima/medial area (0,28±0,11 vs 0,35±0,15; p=0.03), the máximum intimal thickness/medial thickness ratio (0,37±0,17 vs 0,54±0,26; p=0.01), and percent narrowing were all significantly greater in repeat-TRI RAs in the proximal RA.
Optical coherence tomography is a safe and usefull technique to evaluate acute and chronic effects of transradial coronary intervention on the radial artery. There are significant acute injuries and chronic intimal thickening of RA after TRI, mainly in the proximal segment. Further study should evaluate the impact of these effects when TRI RAs are subsequently used as conduits, on long-term graft patency and on clinical outcomes after bypass surgery.