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Published on: September 20, 2020
Time-course of vascular dysfunction of brachial artery after transradial access for coronary angiography
Jerson Munoz-Mendoza1, Abhijit Ghatak2, Veronica Pinto Miranda3
1Department of Medicine, Division of Cardiology, Montefiore Medical Center, The University Hospital for the Albert Einstein College of Medicine, Bronx, New York.
Insights
Transradial cardiac catheterization causes temporary brachial artery dysfunction, affecting both endothelial and smooth muscle cells. This vascular dysfunction resolves within one week post-procedure.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Vascular Biology
Background:
- Previous studies indicate endothelial and smooth muscle brachial artery dysfunction post-transradial cardiac catheterization.
- The duration of this vascular impairment remains undetermined.
Purpose of the Study:
- To ascertain the temporal progression of endothelial and smooth muscle cell dysfunction in the brachial artery following transradial cardiac catheterization.
Main Methods:
- 22 patients undergoing diagnostic transradial cardiac catheterization were assessed.
- High-resolution vascular ultrasound measured brachial artery diameter changes during reactive hyperemia and nitroglycerin administration.
- Measurements were taken at baseline, 6 hours, 24 hours, 1 week, and 1 month post-procedure, with the contralateral artery serving as a control.
Main Results:
- Ipsilateral brachial artery endothelium-dependent dilatation was significantly reduced at 6 and 24 hours post-procedure compared to the contralateral artery.
- Nitroglycerin administration did not alter this difference, indicating smooth muscle dysfunction.
- No significant difference was observed between ipsilateral and contralateral brachial arteries at 1 week and 1 month.
Conclusions:
- Transradial cardiac catheterization induces transient endothelial and smooth muscle dysfunction in the ipsilateral brachial artery.
- This dysfunction fully resolves within one week.
- Findings suggest no systemic vascular dysfunction occurs immediately or one week post-transradial catheterization.
Background:
Prior studies have demonstrated endothelial and smooth muscle brachial artery dysfunction after transradial cardiac catheterization for diagnostic coronary angiography. The duration of this vascular dysfunction is unknown.
Objective:
To determine the time-course of endothelial and smooth muscle cell dysfunction in the upstream brachial artery after transradial cardiac catheterization.
Methods:
We studied 22 consecutive patients with suspected coronary artery disease (age 64.4 ± 7.7 years) undergoing diagnostic transradial cardiac catheterization. Using high-resolution vascular ultrasound, we measured ipsilateral brachial artery diameter changes during reactive hyperemia (endothelium-dependent dilatation) and administration of sublingual nitroglycerin (endothelium-independent dilatation). The measurements were taken at baseline (before cardiac catheterization), 6 h, 24 h, 1 week, and 1 month postprocedure. The contralateral brachial artery served as a control.
Results:
Ipsilateral brachial artery diameter during endothelium-dependent dilatation decreased significantly compared with the contralateral diameters at 6 h and 24 h after transradial cardiac catheterization (3.22 vs. 4.11 and 3.29 vs. 4.11, respectively, P < 0.001). The administration of nitroglycerin did not affect this difference. At 1 week and 1 month postprocedure there was no significant difference in diameter of the ipsilateral versus the contralateral brachial artery. As expected the contralateral brachial artery showed no significant changes in diameter.
Conclusion:
Our results showed that transradial cardiac catheterization causes transient vascular endothelial and smooth muscle dysfunction of the ipsilateral brachial artery, which resolves within 1 week postprocedure. These findings strongly suggest the absence of systemic vascular dysfunction after transradial catheterization both immediately postprocedure as well as 1 week postprocedure. © 2015 Wiley Periodicals, Inc.
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