title: Vascular dysfunction of brachial artery after transradial access for coronary catheterization: impact of smoking and catheter changes.
abstract: OBJECTIVE
  The aim of this study was to investigate the effect of diagnostic transradial catheterization on vascular function of upstream brachial artery (BA).
  
  
  BACKGROUND
  The transradial access has recently become an alternative to transfemoral cardiac catheterization. A potential caveat of this approach lies in possible sustained physical radial artery (RA) damage.
  
  
  METHODS
  We studied 30 patients (age 61 +/- 11 years) undergoing diagnostic coronary angiography with the transradial access (5-F). Endothelium-dependent, flow-mediated vasodilation (FMD) was measured before and at 6 and 24 h after catheterization of the right-sided RA and BA with high-resolution ultrasound. The left-sided RA served as a control.
  
  
  RESULTS
  Transradial catheterization significantly decreased FMD in the RA (overall mean 8.5 +/- 1.7% to 4.3 +/- 1.6%) and the upstream BA (overall mean 4.4 +/- 1.6% to 2.9 +/- 1.6%) at 6 h. Subgroup analysis showed that FMD of both arteries at 6 h was significantly lower in active smokers and that it only remained impaired at 24 h in this group, whereas nonsmoker FMD fully recovered. The degree of BA but not RA FMD dysfunction was related to the number of catheters used, with no change after 2 catheters, 1.9 +/- 1.2% decrease (6 h) and recovery (24 h) after 3 catheters, and 3.9 +/- 1.2% decrease (6 h) without recovery (24 h) after 4 to 5 catheters. The RA dysfunction correlated with the baseline diameter. The contralateral control RA exhibited no change ruling out systemic effects.
  
  
  CONCLUSIONS
  Transradial catheterization not only leads to dysfunction of the RA but also the upstream BA, which is more severe and sustained in smokers and with increasing numbers of catheters.
authors.affiliation: Medizinische Klinik B, Heinrich-Heine University, Düsseldorf, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Heiss
authors.forename: Jan
authors.initials: J
authors.lastname: Balzer
authors.forename: Till
authors.initials: T
authors.lastname: Hauffe
authors.forename: Sandra
authors.initials: S
authors.lastname: Hamada
authors.forename: Emilia
authors.initials: E
authors.lastname: Stegemann
authors.forename: Thomas
authors.initials: T
authors.lastname: Koeppel
authors.forename: Marc W
authors.initials: MW
authors.lastname: Merx
authors.forename: Tienush
authors.initials: T
authors.lastname: Rassaf
authors.forename: Malte
authors.initials: M
authors.lastname: Kelm
authors.forename: Thomas
authors.initials: T
authors.lastname: Lauer
mesh_terms: D000368:Aged; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation; D017023:Coronary Angiography / Q000009:adverse effects* / Q000295:instrumentation; D004867:Equipment Design; D005260:Female; D006801:Humans; D017078:Laser-Doppler Flowmetry; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000008:administration & dosage; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology*; D020127:Recovery of Function; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D013997:Time Factors; D014463:Ultrasonography; D014652:Vascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D014664:Vasodilation / Q000187:drug effects; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D014665:Vasodilator Agents; D005996:Nitroglycerin