Morphological and functional consequences of transradial coronary angiography on the radial artery: implications for its use as a bypass conduit†

Abstract

RA-CA produces extensive damage to the RA. The lesions tend to heal with time but incomplete recovery of endothelial integrity and function is still present more than 30 days after the procedure. After RA-CA, the cannulated RA should not be used for CABG.

Does Previous Transradial Catheterization Preclude Use of the Radial Artery as a Conduit in Coronary Artery Bypass Surgery?

“…A recent study by Gaudino et al 18 has provided further evidence of endothelial damage following TR procedures. This group examined 50 patients who underwent TR coronary angiography (RA-CA) before RA harvesting for CABG, and split the patients into 3 groups depending on the time interval between the RA-CA procedure and the evaluation of their RA (≤24 hours, >24 hours to <7 days, and ≥7 days).…”

“…15,17 In addition to its role in CABG, the RA also is being used with increasing frequency as the access point for coronary angiography and percutaneous coronary interventions in the diagnosis and management of coronary artery disease, respectively. 18 Although, traditionally, the femoral artery has been the preferred route, recent studies have demonstrated that the transradial (TR) approach holds numerous advantages over the transfemoral approach, including decreased bleeding site complications, reduced cost, and a reduction in mortality. 19,20 Moreover, patients prefer the TR approach because of its shorter hospital stay, increased comfort, and better physical functioning postprocedure.…”

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

“…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].…”

“…Additionally, long-term ultrasound examination could find out the incidence of persistent injury or further recovery of vasodilatory function, if any. However, long-term effects of sheath injury are controversial and dependent on the time of assessment after procedure, as discussed previously [6].…”

“…However, it is associated with morphological and functional changes in radial artery (RA) which may lead to occlusion. 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].…”