title: Early and late response-to-injury in patients undergoing transradial coronary angiography: arterial remodeling in smokers.
abstract: OBJECTIVE
  To investigate the effect of smoking on vascular response to transradial coronary angiography (TCA).
  
  
  BACKGROUND
  Cigarette smoking is the most important modifiable cardiovascular risk factor associated with endothelial dysfunction.
  
  
  METHODS
  Radial artery flow-mediated vasodilation (RA-FMD), local stiffness (fractional diameter change), intima-media thickness (IMT), luminal and external arterial diameter were measured in 40 current smokers (CS) and former smokers (FS) at 6-14 months at the site of previous TCA and contralateral control artery. Vascular regenerative capacity was studied as chemotactic cell migration in vitro and ex vivo (n=10) and the time course of endothelial functional recovery following RA-FMD up to 72 h after TCA (n=10).
  
  
  RESULTS
  At 10 ± 3 months after TCA, subjects exhibited significant local stiffening and increased IMT as compared to the control arm. These late structural changes were significantly more pronounced in CS as compared to FS. IMT thickening correlated with packyears, number of daily cigarettes, and inversely with RA-FMD. Nitric oxide synthase (NOS)-dependent chemotaxis of CS' circulating angiogenic cells was impaired. Ex vivo incubation of endothelial cells with CS' plasma inhibited NOS-dependent endothelial wound closure and chemotaxis. In vivo, TCA acutely decreased RA-FMD. At 24 h, RA-FMD had recovered in FS but remained impaired at 24 h and only recovered at 48 h in CS.
  
  
  CONCLUSIONS
  In active smokers, transradial coronary angiography is associated with delayed early recovery from transient endothelial dysfunction, decreased NOS-dependent vascular regeneration, and late arterial remodeling pointing towards potential harmful effects of transradial coronary angiography on vascular function in distinct subsets of patients.
authors.affiliation: Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf Duesseldorf, Germany.
authors.forename: Roberto
authors.initials: R
authors.lastname: Sansone
authors.affiliation: Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf Duesseldorf, Germany.
authors.forename: Emilia
authors.initials: E
authors.lastname: Stegemann
authors.affiliation: Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf Duesseldorf, Germany.
authors.forename: Göksen
authors.initials: G
authors.lastname: Ozaslan
authors.affiliation: Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf Duesseldorf, Germany.
authors.forename: Dominik
authors.initials: D
authors.lastname: Schuler
authors.affiliation: Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf Duesseldorf, Germany.
authors.forename: Margarete
authors.initials: M
authors.lastname: Lukosz
authors.affiliation: Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf Duesseldorf, Germany.
authors.forename: Ana
authors.initials: A
authors.lastname: Rodriguez-Mateos
authors.affiliation: Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf Duesseldorf, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lauer
authors.affiliation: Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf Duesseldorf, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Westenfeld
authors.affiliation: Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf Duesseldorf, Germany.
authors.forename: Malte
authors.initials: M
authors.lastname: Kelm
authors.affiliation: Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf Duesseldorf, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Heiss
keywords: Smoking; endothelial function; intima media thickness; prevention; transradial coronary angiography