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Updated: Aug 16, 2026
Ultrasound Assessment of Endothelial-Dependent Flow-Mediated Vasodilation of the Brachial Artery in Clinical Research
Published on: October 22, 2014
Endothelial vasomotor dysfunction in the brachial artery is associated with late in-stent coronary restenosis
Yoshinobu Kitta1, Takamitsu Nakamura, Yasushi Kodama
1Department of Internal Medicine II, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan.
Insights
Impaired brachial artery flow-mediated dilation (FMD) at follow-up is strongly linked to late in-stent restenosis (ISR) after percutaneous coronary intervention (PCI). This noninvasive FMD test can help identify patients needing further evaluation for ISR.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Vascular Biology
Background:
- Late in-stent restenosis (ISR) detection after percutaneous coronary intervention (PCI) can be challenging.
- Noninvasive methods for identifying ISR are crucial for guiding further diagnostic procedures.
Purpose of the Study:
- To investigate the association between endothelial dysfunction, measured by brachial artery flow-mediated dilation (FMD), and the occurrence of late in-stent restenosis (ISR).
- To determine if FMD assessment can serve as a noninvasive marker for predicting late ISR after PCI.
Main Methods:
- Flow-mediated dilation (FMD) of the brachial artery was assessed before and six months after PCI in 141 patients with bare metal stents.
- Follow-up angiography was performed at six months to diagnose in-stent restenosis (ISR).
- Multivariate logistic regression analysis was used to identify predictors of ISR.
Main Results:
- Impaired FMD at six months post-PCI was significantly associated with late ISR (OR 7.4, p < 0.001), independent of other factors.
- The sensitivity of impaired FMD for detecting ISR (69%) was higher than that of chest pain (45%).
- Combining impaired FMD and chest pain increased ISR detection sensitivity to 90%.
Conclusions:
- Impairment of brachial artery FMD at follow-up is an independent predictor of late ISR in native coronary arteries.
- Noninvasive FMD measurement offers a valuable tool for identifying patients at risk for late ISR, potentially reducing the need for routine angiography.
Objectives:
This study examined whether endothelial dysfunction in the brachial artery might be associated with late in-stent restenosis (ISR) after percutaneous coronary intervention (PCI).
Background:
Simple and noninvasive identification of late ISR might help to select patients who require further angiographic evaluation.
Methods:
Endothelium-dependent flow-mediated dilation (FMD) of the brachial artery was measured before (initial FMD) and at six months (follow-up FMD) after PCI in 141 consecutive patients who had elective and successful PCI with bare metal stents in de novo lesions of native coronary arteries for symptomatic coronary artery disease. Follow-up angiography was performed at six months after PCI in all patients.
Results:
With multivariate logistic regression analysis, the impairment (< or = 4.8% dilation from baseline diameter) of FMD at follow-up showed the strongest association with late ISR (defined as > 50% diameter stenosis, n = 46) independently of other clinical and angiographic variables known to be associated with ISR (odds ratio 7.4, 95% confidence interval 2.8 to 19.2, p < 0.001), whereas the initial FMD did not have the association. The sensitivity of impaired FMD at follow-up (69%) in detecting ISR was higher than chest pain during the follow-up period (45%), with comparable specificity. The impaired FMD in combination with the chest pain increased the sensitivity to 90%.
Conclusions:
The impairment of FMD in the brachial artery at the time of follow-up was independently and closely associated with late ISR in native coronary arteries. The noninvasive assessment of FMD at the time of follow-up might be useful for identification of late ISR.
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