Evaluation of radial artery endothelial functions in transradial coronary angiography

Introduction and Aim: Transradial as a new method for coronary angiography and interventions has recently increased its popularity.But endothelial dysfunction may occur after transradial coronary angiography. We aimed in this study to investigate the endothelial functions and the most reliable intervention through flow mediated vasodilatation test in three different radial access sites: right forearm radial artery, left forearm radial artery and left distal radial artery. Method: Transradial access was used in 70 patients scheduled for coronary angiograpghy and intervention from September 6-th 2017 and March 6-th 2018, prospectively.They were divided into 3 groups: group 1 left forearm radial (17 patients), group 2 left distal radial (27 patients) and group 3 right forearm radial artery (26 patients) access. Flow mediated endothelial functions were measured 3 times; on admission, 24 hour after and 2 months after the procedure. The test was performed with the patient supine, relaxed for 5 minutes. GE Healthcare Vivid E9 4D Cardiovascular ultrasound system instrument, 11L-D, 4.5-12 MHz linear probe was used for radial artery diameter measurement. Arm cuff inflation till 220 mmHg lasted for 5 minutes. After deflation radial artery diameter and their percantage change was recorded in the 1.st, 2nd and 3rd minute. All the data was evaluated by the IBM SPSS Statistics 21.0 programme. Kruskal Wallis test and Anova test was performed for comparison of variables. Results: Mean age was 58,8(±12,3) with male predominance 48(68%,5) and hypertension 54(77,1%), diabetes 28(40%) were the most common risk factors. Radial artery diameters and percent change reached the maximum level in the first minute of flow-through dilation test.In the first 24 hours endothelial function is preserved in left distal radial intervention group compared to right radial intervention group(p<0,001) and left radial intervention group(p=0,043).This preservation continoued at 2 months after the procedure. 64 Radial artery thrombosis 6(8,6%),ecchymosis 4(5,7%) and radial artery occlusion 2(2,9%) were seen in patients but there was no statistical difference between the 3 groups. Only one complication(ecchymosis) was seen in the left distal radial artery access site.There was no statistically significant difference between the 3 groups at the time of fluoroscopy and stent implantation. Conclusion: The radial artery endothelial function is impaired in the first 24 hours but endothelial function is protected by the attempts made in the distal left access compared to the attempts made by the method right-left konvansiyonel. Endothelial dysfunction is reduced in long term follow-up. Left distal radial access is a reliable method of angiography intervention with less risk of arterial vasospasm, occlusion, major bleeding, hematoma. Left distal radial coronary angiography is a method of CAG procedure in which patients are highly satisfied and can recommend to their relatives because the treatment comfort is high and the rate of causing pain that disturb daily activity is low. Keywords: Transradial coronary angiography; Endhotelial function; Flow mediated dilatation test.