Impact of catheter insertion using the radial approach on vasodilation in humans
Résumé
The aim of this study was to determine the impact of catheter sheath insertion, a model of endothelium disruption in humans, on the conventional flow-mediated dilation (FMD) response in vivo. Seventeen subjects undergoing transradial catheterization were recruited and assessed prior to, the day after, and 3-4 months post-catheterization. The catheter sheath's external diameter was 27mm and the average pre-procedure internal radial artery diameter was 28mm, indicating a high likelihood of endothelial denudation as a consequence of sheath placement. Radial artery flow-mediated and endothelium-derived nitric oxide (NO)-dependent function (FMD) was assessed within the region of sheath placement (sheath site) and also above the sheath (catheter site). Glyceryl trinitrate (GTN) endothelium-independent NO-mediated function was also assessed distally. Measurements were made in both arms at all time points; the non-catheterized arm provided an internal control. Neither sheath (4.5±0.9%) nor catheter (4.4±0.9%) insertion abolished FMD, although both significantly decreased FMD from pre-intervention levels (9.0±0.8 sheath segment; 8.4±0.8 catheter segment; P < 0.05). The impact of sheath and catheter placement on FMD was no longer evident after ~3 months recovery (8.0±1.5 and 8.1±1.7%, sheath and catheter, respectively). GTN responses also decreased from 14.8±1.7 to 7.9±1.0% (P < 0.05) as a result of sheath placement, but values returned to baseline at ~3 months (13.0±1.8%). These data suggest that the presence of an intact, functional endothelial layer and consequent NO release may not be obligatory for some component of the FMD response. This raises the possibility of an endothelium-independent contribution to the flow-induced vasodilation in humans.
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