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Updated: Feb 28, 2026
Ultrasound Assessment of Endothelial Function: A Technical Guideline of the Flow-mediated Dilation Test
Published on: April 27, 2016
Evaluation of endothelial dysfunction with flow-mediated dilatation after transradial coronary angiography
Bahar T Tak1, Kevser G Balci1, Hilal Erken2
1a Turkiye Yuksek Ihtisas Research and Education Hospital , Ankara , Turkey.
Insights
Transradial coronary angiography (TRCA) can impair endothelial function, particularly with multiple punctures or longer procedures. Operator experience significantly influences outcomes, with experienced operators preserving radial artery function better.
Area of Science:
- Cardiology
- Vascular Biology
- Interventional Radiology
Background:
- Transradial coronary angiography (TRCA) is a common procedure, but potential complications like endothelial dysfunction require investigation.
- Understanding factors influencing TRCA-related endothelial dysfunction is crucial for optimizing patient outcomes and procedural safety.
Purpose of the Study:
- To investigate the incidence of endothelial dysfunction following TRCA.
- To determine the relationship between operator experience, number of punctures, and procedure duration with TRCA-induced endothelial dysfunction.
Main Methods:
- A cohort of 57 patients undergoing TRCA were assessed nine months post-procedure.
- Radial artery endothelial function was evaluated using B-mode ultrasound with flow-mediated dilatation (FMD) and nitroglycerin-mediated dilatation (NMD) techniques.
- The non-intervened radial artery served as a control for comparison.
Main Results:
- Flow-mediated dilatation (FMD) was significantly reduced in the intervened radial artery compared to the control (10.1% vs. 13.6%, P=0.041), indicating endothelial dysfunction.
- Nitroglycerin-mediated dilatation (NMD) showed no significant difference between the arteries (23.4% vs. 23.8%, P=0.932).
- Higher puncture numbers (P=0.005), longer procedure durations (r=-0.349, P=0.008), and less operator experience (P=0.002) were associated with worse FMD in the intervened artery.
Conclusions:
- Transradial coronary angiography can induce endothelial dysfunction, primarily assessed by FMD.
- Factors such as multiple punctures, prolonged procedure times, and limited operator experience negatively impact post-TRCA endothelial function.
- Optimizing procedural techniques and operator training may mitigate TRCA-related endothelial dysfunction.
Abstract:
Objective Transradial coronary angiography (TRCA) may lead to endothelial dysfunction. Therefore, this study investigated the TRCA-related endothelial dysfunction and its relation to operator experience, the number of punctures and procedure duration. Methods and results A total of 57 patients (42 males and 17 females) who underwent TRCA were included in this single-centre study. Nine months after the procedure, all patients underwent radial artery B-mode ultrasound imaging, and flow-mediated dilatation (FMD) and nitroglycerin-mediated dilatation (NMD) techniques were employed. The non-intervened right radial artery was accepted as control. The percentage change in diameter after FMD was significantly greater in the right radial artery compared to the left radial artery (right 13.6% vs left 10.1%, P = 0.041). The percentage change in diameter after NMD was similar in both right and left radial arteries (right 23.8% vs left 23.4%, P = 0.932). According to the puncture numbers, the percentage change was significantly lower in the intervened artery among patients with more than one puncture (13.3% vs 7.8%, P = 0.005). According to the operator experience, the percentage change in the intervened artery was significantly higher in patients in whom the procedure was performed by experienced operators (13.7% vs 7.6%, P = 0.002). The procedure duration also showed a negative correlation with the percentage change in the intervened artery (r = -0.349, P = 0.008). Conclusions TRCA may lead to endothelial dysfunction represented by FMD. Moreover, higher puncture numbers for sheath insertion, longer procedure durations and less experience in radial interventions may have adverse effects on the endothelial function.
