This document discusses the impact of transradial artery catheterization (TRA) on radial artery vasomotion. TRA can cause both non-occlusive and occlusive injury to the radial artery from denudation, rupture, intimal tears, or dissections. Studies show TRA causes transient impairment of the radial artery's flow-mediated dilation (FMD) and nitrate-mediated dilation (NMD), measures of endothelial and smooth muscle function, that recover over time. Understanding the temporal changes in FMD and NMD after TRA may help determine when repeat TRA can be performed with minimal risk of complications. Further research in larger studies is still needed to fully characterize the changes in radial artery vasomotion and their clinical implications over

1. Impact of Transradial
Artery Catheterisation on
Radial Artery Vasomotion
Jerson Munoz Mendoza, MD
Montefiore - Einstein Center for Heart and Vascular Care
The University Hospital for Albert Einstein College of Medicine

2. Disclosures
› None

3. Outline
› Background
› Vascular function and vasomotion
› Determinants of vasomotion
– Endothelium/FMD
– Smooth muscle/NMD
› Data of the impact of TRA on radial vasomotion
› Implication on clinical outcomes
› Future directions

4. Ann Thorac Surg 1997;63:1346-52
Background

6. Endothelial function
1. Regulates fluid and molecule traffic between blood and tissues
2. Serves as an anti-coagulant surface
3. Contributes to vascular homeostasis and repair
4. Plays a central role in angiogenesis and tissue wound healing
5. Plays a vital role in vascular tone and blood flow regulation

7. Vascular Reactivity ( = Vasomotion)
Dependant of the function of the
endothelium and vascular smooth muscle
Is the most important element of
vascular function
Increase in arterial blood flow in
response to a number of stimuli
J Am Coll Cardiol Intv 2009;2:1067–73

9. Impaired vascular reactivity
=
Vascular dysfunction
Endothelial
dysfunction
Smooth muscle
dysfunction
FMD NMD
Therefore …

11. Chest 2005; 127:2254–2263
Reactive
Hyperemia
Physiology of FMD

12. What is the impact of transradial artery
catheterisation on radial artery vasomotion ?

13. Mechanisms of radial artery injury
Denudation Rupture

14. Radial artery injury following TRA
1. NON-OCCLUSIVE: RAS
2. OCCLUSIVE: RAO
› Functional
– Endothelial dysfunction
– Smooth muscle dysfunction
› Structural
– Intimal tear
– Medial dissection
– Intimal hyperplasia

15. Resting diameter FMD NMD
Burstein et al, Am J Cardiol 2007;99:457– 459

16. Heiss at al, J Am Coll Cardiol Intv 2009;2:1067–73

17. 6H 24H 1W 1M 9-10W 3Mo 6Mo 9Mo 1Y
Resting
FMD
NMD
Burstein, 2007
Maddsen, 2006
Park, 2012
Heiss, 2009
Dawson, 2010
Okuyan, 2012
Sanmartin, 2004
Changes in radial artery vasomotion across time after TRA
At baseline:
- Median resting diameter: 2.65 mm (2.36 – 2.80 mm)
- Median sheath size: 6 Fr ( 2.7 mm)

18. FMD
Burstein et al, Am J Cardiol 2007;99:457– 459

19. J Am Coll Cardiol 2003;41:1109 –14

20. Repeat TRIFirst TRI
European Heart Journal (2010) 31, 1608–1615

21. How these changes in the radial artery
vasomotion translate in clinical outcomes ?
- Acute consequences ( e.g., radial artery vasospasm)
- Long-term consequences ( e.g., for re-access or for use as bypass graft)

22. Radial artery spasm

23. 2.7 % RAS
0.7 % crossover rate
Catheterization and Cardiovascular Interventions 83:E32–E36 (2014)

24. Ann Thorac Surg 2003;76:1505–9
Pre TRA
No TRA

25. Cathet Cardiovasc Intervent 2001;54:204–20

26. European Heart Journal (2010) 31, 1608–1615

27. Future directions
› A better understanding of the changes in the vascular function of
the radial artery after TRA possibly could help us to determine the
ideal time for repeat TRA with minimal risk of complications
› Potential role of trimetazidine in accelerating the recovery of FMD
of the radial artery after TRA

28. J Interven Cardiol 2012;25:411–417

29. Conclusions
› TRA produces transient changes in the vasoreactivity of
the radial artery as the result of the interaction of the
sheath, catheter and artery lumen
› These changes encompass the endothelial and smooth
muscle cell function.
› Understanding the temporal changes of FMD and NMD of
the radial artery after TRA can provide the substrate to
determine the right timing for repeat TRA.
› The temporal pattern of these changes and their
implications on clinical outcomes are yet to be
established in larger studies

30. Jerson Munoz Mendoza, MD
jermendo@montefiore.org