Impact of catheter insertion using the radial approach on vasodilatation in humans

Abstract

The aim of this study was to determine the impact of catheter sheath insertion, a model of endothelium disruption in humans, on the conventional FMD (flow-mediated dilatation) response in vivo. Seventeen subjects undergoing transradial catheterization were recruited and assessed prior to, the day after, and 3-4 months postcatheterization. The catheter sheath's external diameter was 2.7 mm, and the average preprocedure internal radial artery diameter was 2.8 mm, indicating a high likelihood of endothelial denudation as a consequence of sheath placement. Radial artery flow-mediated and endothelium-derived NO (nitric oxide)-dependent function (FMD) was assessed within the region of sheath placement (sheath site) and also above the sheath (catheter site). GTN (glyceryl trinitrate) endothelium-independent NO-mediated function was also assessed distally. Measurements were made in both arms at all time points; the non-catheterized arm provided an internal control. Neither sheath (4.5+/-0.9%) nor catheter (4.4+/-0.9%) insertion abolished FMD, although both significantly decreased FMD from preintervention levels (9.0+/-0.8% sheath segment; 8.4+/-0.8% catheter segment; P<0.05). The impact of sheath and catheter placement on FMD was no longer evident after approximately 3 months recovery (8.0+/-1.5 and 8.1+/-1.7%, sheath and catheter, respectively). GTN responses also decreased from 14.8+/-1.7 to 7.9+/-1.0% (P<0.05) as a result of sheath placement, but values returned to baseline at approximately 3 months (13.0+/-1.8%). These results suggest that the presence of an intact, functional endothelial layer and consequent NO release may not be obligatory for some component of the FMD response. This raises the possibility of an endothelium-independent contribution to the flow-induced vasodilatation in humans.

Incidence and predictors of radial artery injury following transradial procedures: Yet another benefit of renin–angiotensin system blockade?

“…Transradial catheterization disrupted NMD with a similar extent to FMD in our study. This effect on NMD has been consistently observed in previous studies as well [9][10][11][12], which means that transradial procedures traumatize not only endothelial layer but arterial wall as a whole. RA diameter and potential procedure time were associated with NMD impairment in this study.…”

“…Endothelial dysfunction of RA possibly results from endothelial denudation injury as induced in animal models [15]. Complete or incomplete recovery of endothelial dysfunction is expected from as early as 24 h [16] up to 14 months after procedure [6,9,12,17] although persistent impairment of RA function has also been reported [7,10,11,13].…”

“…Previous studies with intravascular ultrasound, optical coherence tomography and histological examination revealed that intimal hyperplasia or intima-media thickening, peri-arterial tissue or fat necrosis and adventitial inflammation was evident in previously catheterized RA [2][3][4][5][6]. Vasodilator function of RA following transradial procedures was studied extensively as well, most studies reporting a decline in endothelium-dependent or independent vasodilation in acute phase followed by some recovery in long-term [6][7][8][9][10][11][12][13]. It is uncertain, however, whether vasodilatory function gets impaired in every patient or not.…”

Impact of 2‐Weeks Continuous Increase in Retrograde Shear Stress on Brachial Artery Vasomotor Function in Young and Older Men

“…Before, 30 minutes following, and 2 weeks after sleeve application, endothelium‐dependent,33 mainly NO‐mediated,34 vasodilator function was examined using the flow‐mediated dilation (FMD%). First, subjects rested in the supine position for at least 15 minutes to facilitate baseline assessment of heart rate and blood flow.…”

Ventricular-Arterial Coupling in Breast Cancer Patients After Treatment With Anthracycline-Containing Adjuvant Chemotherapy

“…This suggests that none of these aforementioned causes appear to be the case. The brachial artery endothelium has been shown to possess an inherent plasticity with the removal of an acute perturbation (e.g., after arterial catheter insertion, FMD will recover completely over a period of several months [33]). It is possible that in this sample a similar temporal pathophysiology has occurred, although prospective longitudinal assessment is required.…”