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Published on: September 20, 2020
Histopathologic changes of the radial artery wall secondary to transradial catheterization
Cezar S Staniloae1, Kanika P Mody, Kintur Sanghvi
1Saint Vincent's Hospital Manhattan, New York, NY 10011, USA. cstaniloae@svcmcny.org
Insights
Transradial catheterization causes histological changes like intimal hyperplasia and inflammation at the radial artery puncture site. These injuries appear localized, with no significant changes observed in the proximal artery segments.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Histopathology
Background:
- Transradial access is a common method for cardiac catheterization.
- The histological impact of transradial access on the radial artery wall remains largely uncharacterized.
Purpose of the Study:
- To investigate the immediate histological alterations in the radial artery following transradial catheterization.
- To compare histological findings between catheterized and non-catheterized radial arteries.
Main Methods:
- Radial arteries from 34 patients undergoing coronary artery bypass grafting were analyzed.
- Histological examination of proximal and distal segments for intimal hyperplasia, inflammation, and necrosis.
- Comparison between 15 previously catheterized (TRA group) and 19 non-catheterized arteries (NCA group).
Main Results:
- The distal radial artery segments in the TRA group showed significantly increased intimal hyperplasia, periarterial tissue necrosis, and adventitial inflammation compared to the NCA group.
- These histological changes were significantly more pronounced in the distal segments of the TRA group compared to their proximal segments.
- No significant histological differences were observed in the proximal segments between the TRA and NCA groups.
Conclusions:
- Transradial catheterization induces localized histological injury to the radial artery at the puncture site.
- Observed changes include intimal hyperplasia, medial inflammation, and tissue necrosis.
- The study highlights the localized nature of transradial access-induced vascular changes.
Objective:
The immediate effects of transradial access on the radial artery wall are unknown. In this study we sought to assess the histological changes induced by catheterization on the radial artery.
Methods:
Thirty-four patients undergoing coronary artery bypass grafting (CABG) had radial arteries harvested to serve as bypass conduits. The proximal and distal ends of the radial artery conduits were sectioned and embedded in paraffin. Both ends of all specimens were evaluated by a blinded pathologist for intimal hyperplasia, medial inflammation, medial calcification, periarterial tissue or fat necrosis, adventitial inflammation, adventitial necrosis, and adventitial neovascularization. Fisher's exact test was used for statistical analysis.
Results:
Fifteen previously catheterized radial arteries (TRA group) were compared with 19 noncatheterized arteries (NCA group). The distal ends of the TRA group showed significantly more intimal hyperplasia (73.3% vs 21.1%; p = 0.03), periarterial tissue or fat necrosis (26% vs 0%; p = 0.02), and more adventitial inflammation (33.3% vs 0%; p = 0.01) than the distal ends of the NCA group. The distal ends of the TRA group also showed significantly more intimal hyperplasia (73.3% vs 26.6%; p = 0.03) and adventitial inflammation (33.3% vs 0%; p = 0.01) than the proximal ends of the same arteries. There were no histological differences in the proximal ends of the two groups.
Conclusion:
Transradial catheterization induces significant histological changes suggestive of radial artery injury limited to the puncture site in the form of intimal hyperplasia, medial inflammation, and tissue necrosis. Both the proximal and distal ends of the radial artery show a spectrum of atherosclerotic changes independent of its use for transradial catheterization.
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