The impact of transradial coronary procedure on endothelial function of radial artery

Transradial approach has become a popular method for coronary angiography. Endothelial dysfunction of the radial artery due to the procedure can cause problems for the use of the radial artery as grafts for CABG and shunt operations. In this study, we aimed to show the short and long term effects of the catheterization to the radial artery endothelial function. The primary endpoint of this study is the evaluation of the radial artery endothelial function after catheterisation. The secondary endpoints are as follows: The frequency of the radial artery occlusion, the determining factors causing occlusion, evaluating the loss of arm strength, procedure comfort, the factors affecting the radial artery endothelial function, artery diameter before and after the coronary angiography. 43 patients were admitted in prospective manner. The radial artery endothelial function has been assessed by means of the flow-mediated and by the nitroglycerin-mediated vasodilation tests and arm strength was assessed by Jamar hand dynamometer prior to catheterization. These tests were repeated at 24 hours and 8 weeks after the procedure. The radial artery endothelial function has been impaired in the first 24 hours (p<0,05). However at the 8 week controls, the radial artery endothelial functions returned to the prior catheterization levels (p>0,05). The frequency of radial artery occlusion was 23% (10 patients). There were no independent risk factors for predicting the radial artery occlusions. There were statistically significant losses in the left hand grip strength at 8 weeks after the procedure. The radial artery diameters were significantly enlarged at 24 hours (p<0,05) but returned to baseline at 8 weeks after the catheterisation. At 8 weeks including the radial artery catheterisation procedure, smoking was the only independent risk factor which impaired the radial artery endothelial function (p=0,002). In conclusion; the radial artery endothelial function is impaired in the first 24 hours but returned to normal at follow up after radial angiography. The ultrasonographic incidence of radial artery occlusion is high after radial angiography. It is safe to use radial arteries as grafts in CABG and shunt operations but the high number of radial artery occlusions may limit the use of grafts after catheterisation. There is a loss of arm strength after radial catheterisation which does not cause any functional symptoms. Keywords: Radial angiography, endothelial dysfunction, flow-mediated and nitroglycerin-mediated vasodilatation