Vascular Dysfunction of Brachial Artery After Transradial Access for Coronary CatheterizationImpact 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
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Figure 1 Functional Impairment of Conduit Arteries After Transradial Coronary Angiography
(A) Schematic of experimental setup: after cannulation of the right radial artery (RA), a coronary angiography catheter is advanced through the RA and brachial artery (BA), and coronary angiography is performed. (B to G) This leads to impairment of endothelium-dependent and glycerol trinitrate (GTN)-induced endothelium-independent vasodilator function. The lack of change in wall shear stress (WSS) representing the driving force for endothelium-dependent flow-mediated vasodilation (FMD) suggests that the injury did not affect the microvasculature and was therefore rather located in the macrovasculature response to WSS. (H to J) Function of the left contralateral RA is used as a control and remained unchanged. *p < 0.05 vs. baseline; #p < 0.05 vs. 6 h (1-way analysis of variance). B = baseline reading before catheterization.
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Figure 2 Vascular Dysfunction Depends on Number of Catheters and Smoking Status
The degree of vascular dysfunction expressed as a decrease in FMD at 6 h and recovery at 24 h as compared with baseline after transradial cardiac catheterization is correlated to the number of catheters used in the (B) BA but not the (A) RA likely due to relative protection from further injury by the sheath, which was at the site of RA FMD measurements. *p < 0.05 vs. 2 catheters; #p < 0.05 vs. 3 catheters. Furthermore, (C and D) smokers exhibit a significantly greater degree of dysfunction that does not recover within the observation period of 24 h. *p < 0.05 vs. baseline; #p < 0.05 vs. nonsmokers (2-way analysis of variance). Abbreviations as in Figure 1.
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