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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Impact of introducer sheath coating on endothelial function in humans after transradial coronary procedures
Ellen A Dawson1, Sudhir Rathore, N Timothy Cable
1Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, and Liverpool Heart and Chest Hospital, Liverpool, England, UK. e.dawson@ljmu.ac.uk
Insights
Transradial catheterization temporarily impairs radial artery vasodilator function, regardless of sheath coating. Functionality fully recovers within three months post-procedure, indicating no significant difference between hydrophilic-coated and uncoated sheaths.
Area of Science:
- Cardiovascular Medicine
- Vascular Biology
- Interventional Cardiology
Background:
- Transradial catheterization is a common procedure for cardiac interventions.
- The impact of catheter sheath material on vascular function requires further investigation.
- Nitric oxide (NO)-mediated vasodilation is crucial for maintaining vascular health.
Purpose of the Study:
- To compare the effects of hydrophilic-coated versus uncoated catheter sheaths on NO-mediated endothelial-dependent and -independent vasodilator function after transradial catheterization.
- To assess the recovery of vasodilator function post-procedure.
Main Methods:
- A comparative study involving 35 subjects undergoing transradial catheterization.
- Assessment of radial artery flow-mediated dilatation and glyceryl trinitrate-induced vasodilation before and after catheterization.
- Comparison between subjects receiving hydrophilic-coated (n=15) and uncoated (n=20) sheaths.
- Utilized the non-catheterized arm as an internal control.
Main Results:
- Transradial catheterization significantly decreased both flow-mediated dilatation and glyceryl trinitrate-induced vasodilation in the catheterized arm.
- These functional impairments returned to baseline levels approximately 3 months after the procedure.
- No statistically significant differences in the magnitude of functional decrease or recovery were observed between the hydrophilic-coated and uncoated sheath groups.
Conclusions:
- Catheter sheath placement during transradial catheterization temporarily disrupts radial artery vasodilator function.
- Vascular function recovers within a 3-month period following the procedure.
- Hydrophilic-coated and uncoated sheaths demonstrate comparable impacts on radial artery vasodilator function.
Background:
The aim of this study was to compare the impact of transradial catheterization with hydrophilic-coated catheter sheaths versus uncoated sheaths on NO-mediated endothelial-dependent and -independent vasodilator function.
Methods And Results:
Thirty-five subjects undergoing transradial catheterization were recruited and assessed before and the day after catheterization. A subgroup was also assessed 3 to 4 months after catheterization. Subjects received hydrophilic-coated sheaths (n=15) or uncoated sheaths (n=20). Radial artery flow-mediated dilatation and endothelium- and NO-dependent arterial dilatation were assessed within the region of sheath placement. Glyceryl trinitrate endothelium-independent NO-mediated function was also assessed. The noncatheterized arm provided an internal control. Flow-mediated dilatation in the catheterized arm decreased from 10.3+/-3.8% to 5.3+/-3.3% and 8.1+/-2.4% to 5.2+/-3.7% in the coated and uncoated groups, respectively (P<0.01). These values returned toward baseline levels approximately 3 months later (coated, 6.4+/-1.4%; uncoated, 9.4+/-4.1%; P<0.05) versus postprocedure. Glyceryl trinitrate decreased from 14.8+/-7.2% to 9.5+/-4.1% (P<0.05) in the coated group and from 12.2+/-4.6% to 7.5+/-4.2% (P<0.01) in the uncoated group. Values returned to baseline at approximately 3 months (coated, 16.6+/-5.6%; uncoated, 12.1+/-3.9%; P<0.05). There was no difference in the magnitude of decrease in flow-mediated dilatation or glyceryl trinitrate between coated and uncoated groups. No changes in function occurred in the noncatheterized arm.
Conclusions:
Placement of a catheter sheath inside the radial artery disrupts vasodilator function, which recovers after 3 months. No differences were evident between hydrophilic-coated and uncoated sheaths.
