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Transradial Access-Induced Injury During Invasive Coronary Angiography: A Histological Analysis to Guide Radial
Garry W Hamilton1, Christopher B Freelance2, Jessica Beechey3
1Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Vic, Australia.
Background:
Transradial access (TRA) for invasive coronary angiography (ICA) can injure the radial artery (RA). We investigated the distribution of injury to propose injury-mitigation strategies to maximise RA conduit availability for coronary artery bypass grafting (CABG).
Method:
This was a single-centre study including 24 patients who underwent CABG with both the left and right RA after TRA for ICA. Four tissue samples were acquired from each patient: the proximal (subjected to wires and catheters during the ICA) and distal (subjected to the sheath during ICA) instrumented and non-instrumented RAs. Histological analyses assessed regional differences in injury to the instrumented as compared to the non-instrumented RA.
Results:
The distal instrumented RA intima-to-media ratio was higher compared to both the proximal instrumented RA (p=0.009) and the proximal non-instrumented RA (p=0.005). No difference was seen in the density of fibrosis in the media (beta regression: χ2=3.459; p=0.33). There were no statistically significant differences in the presence or absence of inflammation, fibrosis, intimal thickening, calcification, disruption or duplication of the internal elastic lamina, or intimal injury and erosion (Pearson's chi-squared: χ2=10.572, df=15; p=0.78). Visual inspection of the correlation plot of the residuals suggested a higher-than-expected count of inflammation in the instrumented RA, and a higher-than-expected rate of fibrosis in the proximal instrumented RA.
Conclusions:
Instrumented RA conduit deemed suitable for grafting has histological changes induced by TRA. Although the injury pattern varies, the intima-to-media ratio differences suggest intimal proliferation is greatest in the sheath-exposed distal RA, while the qualitative findings suggest reactive changes are more apparent in the instrumented RA as a whole. The findings suggest the smallest possible sheath and catheters should be considered during ICA, particularly in patients with a high index of suspicion of needing CABG, to help maximise RA conduit availability.
