title: Incidence and predictors of radial artery injury following transradial procedures: Yet another benefit of renin-angiotensin system blockade?
abstract: BACKGROUND
  Vasodilatory function of radial artery (RA) declines following the transradial catheterization. However, it is uncertain whether impaired vasodilatory function develops in every patient. The aim of this study was to investigate the incidence and predictive factors of impaired vasodilatory function following transradial procedures.
  
  
  METHODS
  Consecutive patients undergoing elective transradial procedures were prospectively enrolled. Ultrasound examination of RA was recorded just before and 1 week after the procedure. RA diameters and flow velocities were measured at baseline, after flow mediated vasodilation (FMD) and after nitrate mediated vasodilation (NMD).
  
  
  RESULTS
  Fifty-one patients were included (62 ± 11 years, 55% male, 41% hypertensive, 20% diabetic, 65% with coronary artery disease). Overall FMD and NMD were significantly impaired after 1 week. However, deterioration of FMD and NMD was observed in 67% and 71% of patients, respectively. Absolute change in FMD was significantly different in patients using a renin- angiotensin system (RAS) inhibitor compared to those who were not (1.9 ± 12.9 vs. -7.7 ± ± 12.7%, respectively, p = 0.025). Additionally, there was a moderate but significant correlation between baseline RA diameter and absolute change in NMD (r = 0.419, p < 0.001). RAS blockade was independently associated with protection against FMD deterioration (OR 0.241, 95% CI 0.066-0.883, p = 0.032), whereas RA diameter (OR 0.079, 95% CI 0.009-0.720, p = 0.024) and procedure time (OR 1.156, 95% CI 0.989-1.350, p = 0.068) were associated with NMD deterioration, although the latter had borderline significance.
  
  
  CONCLUSIONS
  Vasodilatory function of RA gets impaired in most patients following transradial procedures. RAS blockade seems to exert a protective role against deteriorating endothelium- dependent vasodilation, whereas smaller RA diameter and potentially longer procedure time are associated with impaired endothelium-independent vasodilation.
authors.affiliation: Department of Cardiology, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey. drburakturan@gmail.com.
authors.forename: Burak
authors.initials: B
authors.lastname: Turan
authors.forename: Ayhan
authors.initials: A
authors.lastname: Erkol
authors.forename: Fatih
authors.initials: F
authors.lastname: Yılmaz
authors.forename: Mehmet Mustafa
authors.initials: MM
authors.lastname: Can
authors.forename: İsmail
authors.initials: İ
authors.lastname: Erden
mesh_terms: D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001783:Blood Flow Velocity; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology; D015994:Incidence; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D065840:Protective Factors; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000293:injuries / Q000503:physiopathology; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012307:Risk Factors; D013997:Time Factors; D014421:Turkey / Q000453:epidemiology; D057772:Vascular System Injuries / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D014664:Vasodilation / Q000187:drug effects*; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D014665:Vasodilator Agents
keywords: catheterization; endothelium; radial artery; renin–angiotensin system; vasodilation