Impact of percutaneous invasive coronary procedures using a radial approach on endothelial function of radial artery

Introduction

Endothelium is the most inner layer of the artery which is crucially engaged in processes of vasodilatation. The regulation of blood flow is implemented due to synthesis and release of nitric oxide (NO) distributed by eNOS, which causes the ability of the artery to react to ischemia [1–3]. Nitric oxide primarily dilates the artery but is also a protective factor which lowers the inflammatory response in the artery [2–4]. It has been proven that dysfunction of the endothelium due to lowered bioavailability of NO is a key factor in the origin of atherosclerosis and may lead to higher risk of heart-vascular mortality [2–4].
The radial approach is the most preferred option during performing percutaneous coronary intervention (PCI). Its superiority compared to the femoral access is reflected in a lowered rate of periprocedural death and lowered risk of mortality established [4–12] on reduction of major bleeding and access site complications, which is crucially important in therapy engaging greater anticoagulation [13–15]. Comfort of the patient and earlier mobilization are additional advantages [5, 7]. It seems that over 90% of all coronary angiographies and PCIs can be performed using a radial approach and in Poland the radial artery has become the default approach for angiography and PCI [16, 17]. However, inserting the catheter sheath by the radial approach during PCI and coronary angiography procedures traumatizes the inner layer of the artery and negatively affects the synthesis of NO [1]. Nevertheless, the distinct impact of invasive procedures on the vascular response of arteries is not well known yet. One way of examining the function of endothelium is by flow-mediated dilatation (FMD). It compares the radial artery diameter before and after ischemia caused by clenching the cuff on the arm [3, 4]. Therefore, measurement of this parameter and blood flow velocity of the radial artery before and after invasive procedures may seem to be the best option to determine how endothelial function is impaired by catheter and sheath maneuvers.

Aim

The aim of this study is to compare endothelial function before and after invasive coronary procedures (angiography, PCI).

Material and methods

Informed written consent was obtained from 15 male patients. They were recruited prospectively from the list of subjects requiring elective coronary catheterization for coronary angiography or angioplasty with stable angina...


View full text...