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Vascular Dysfunction of Brachial Artery After Transradial Access for Coronary Catheterization

Impact of Smoking and Catheter Changes

Christian Heiss, MD^_*, Jan Balzer, MD^_*, Till Hauffe, BS, Sandra Hamada, MD, Emilia Stegemann, MD, Thomas Koeppel, MD, Marc W. Merx, MD^_*, Tienush Rassaf, MD^_*, Malte Kelm, MD^_*, Thomas Lauer, MD^_*,_*

^_* Medizinische Klinik B, Heinrich-Heine University, Düsseldorf, Germany
Medizinische Klinik I, European Vascular Center Aachen-Maastricht, University Hospital Aachen, Aachen, Germany
Department of Vascular Surgery, European Vascular Center Aachen-Maastricht, University Hospital Aachen, Aachen, Germany

^_* Reprint requests and correspondence: Dr. Thomas Lauer, Medizinische Klinik B, Heinrich-Heine University, Moorenstrasse 5, 40225 Düsseldorf, Germany (Email: thomas.lauer{at}med.uni-duesseldorf.de).

Objectives: The aim of this study was to investigate the effect of diagnostic transradial catheterization on vascular function of upstream brachial artery (BA).

Background: The transradial access has recently become an alternative to transfemoral cardiac catheterization. A potential caveat of this approach lies in possible sustained physical radial artery (RA) damage.

Methods: We studied 30 patients (age 61 ± 11 years) undergoing diagnostic coronary angiography with the transradial access (5-F). Endothelium-dependent, flow-mediated vasodilation (FMD) was measured before and at 6 and 24 h after catheterization of the right-sided RA and BA with high-resolution ultrasound. The left-sided RA served as a control.

Results: Transradial catheterization significantly decreased FMD in the RA (overall mean 8.5 ± 1.7% to 4.3 ± 1.6%) and the upstream BA (overall mean 4.4 ± 1.6% to 2.9 ± 1.6%) at 6 h. Subgroup analysis showed that FMD of both arteries at 6 h was significantly lower in active smokers and that it only remained impaired at 24 h in this group, whereas nonsmoker FMD fully recovered. The degree of BA but not RA FMD dysfunction was related to the number of catheters used, with no change after 2 catheters, 1.9 ± 1.2% decrease (6 h) and recovery (24 h) after 3 catheters, and 3.9 ± 1.2% decrease (6 h) without recovery (24 h) after 4 to 5 catheters. The RA dysfunction correlated with the baseline diameter. The contralateral control RA exhibited no change ruling out systemic effects.

Conclusions: Transradial catheterization not only leads to dysfunction of the RA but also the upstream BA, which is more severe and sustained in smokers and with increasing numbers of catheters.

Key Words: flow-mediated dilation • transradial cardiac catheterization • vascular dysfunction

Abbreviations and Acronyms   ANOVA = analysis of variance   BA = brachial artery   CAD = coronary artery disease   FMD = flow-mediated vasodilation   GTN = glycerol trinitrate   RA = radial artery   WSS = wall shear stress