The Effects On Diameters,Haemodynamics And Elasticity Of Radial Artery Through Transradial Coronary Interventional Procedures

Recently,the transradial coronary intervention was more and more common due to the equipment of coronary artery intervention increasingly miniaturization. Transradial coronary intervention,although a relatively new procedure,has the potential to shorten hospitalization,speed patient mobilization,decrease nursing care,and lower complication rates. Although its security was confirmed, a transradial catheterization induces a trauma to the radial artery (RA). There is a paucity of data demonstrating the potential influnce of transradial catheterization on acute stage and long-term structure and function of the RA.Few research focus on its morphology changes such as diameter,haemodynamics and elasticity.RA was introduced as an alternative conduit in coronary surgery by Carpentier and colleagues in 1973.Although initial results were promising,the use of the RA as by pass graft was later abandoned due to others demonstrating increased occlusion rates.Later,improved harvesting techniques and use of antispastic agents led to a revived interest in arterial revascularization,including a resurgence in the use of RA as conduit.Recently,several studies with favorable clinical and angiographic results obtained with the use of RA as coronary bypass graft have been published,and the RA has become the second choice of arterial graft after the left internal mammary artery.During the last years,there has been an increased interest in the RA as an entry route during coronary angiography and percutaneous coronary interventions.A transradial catheterization induces a trauma to the RA that could possibly influence the function if subsequently used as a bypass graft.There is a paucity of data demonstrating the potential influnce of transradial catheterization on long-term structure and function of the RA. Whether its long-term changes could affect it as a conduit in coronary artery revascularization is also the focus of cardiovascular surgery.RAO is the most commen complication of transradial coronary intervention.Although its clinical symptom was seldom emerged, it brought about psychological burden on patients.The most important thing is that they possibly accepted PCI many times. The process in many patients were complicated and multiple–vessel.To recheck the coronary and revascularization is necessary. If radial artery was occluded,it certainly affect the choice of PCI approach. Touching pulse was traditionally used as a method to diagnose RAO ,but it is not accurate.ultrasounic diagnosis is more confident. So to evaluate the incidence and risk factors of acute radial artery occlusion following transradial coronary intervention could give a good gidence of clinical practice.The purpose of this subject was to evaluate the effects of transradial interventional procedure on diameters,haemod -ynamics and elasticity of radial artery.Part 1 The effects on diameters,haemodynamics and elasticity of radial artery through transradial coronary interventional procedures in 48～72 hour Objective To evaluate the effects of transradial interventional procedure on diameters,haemodynamics and elasticity of radial artery in the near future; To estimate the security of transradial coronary intervention.Methods 232 patients, who were diagnosed coronary heart disease (CHD) at the Cardiology Department of General Hospital of Armed Police Forces on March,2007 to July,2007,including 155(66.81%) male and 97(33.19%) female patients with average age of 59.69±11.73,were underwent transradial interventional procedure of coronary artery.Diam -eters and systolic peak velocity (SPV) of the right radial artery were measured with 2-dimensional and color doppler ultrasound before the procedure,48～72 hour later.Every index was measured three times.At meantime, carotid-radial pulse wave velocity (CR-PWV) was measured.Results1,In the angiography result of 232 patients,there were 53 cases (22.8%) negative, 179 cases(77.2%) positive.Among them,142 cases were undertaken PCI.The puncture of radial artery was successful in 224 patients.In failed 5 cases,it was turned to transfemoral approach with success because of weakly pulses. 3 cases turned to left artery due to dysplasia or circuity of right atery. There were 5 cases forearm haematoma,2 cases pseudoaneurysm,20 cases(8.6%) arterial occlusion after this procedure.2,48～72 hour later,197 cases(87.9%) were followed up, including 133 male(67.5%) and 64 female(32.5%) patients with average age of 60.70±11.23.Their diameters and velocities of all segments were measured successfully. Their diameters were 1.95±0.41mm,2.23±0.56mm,2.59±0.52mm,respectively. Their systolic peak velocites were 59.97±20.51cm/s, 62.36±18.08cm/s, 62.15±24.24cm/s,respectively.The diameter of female were smaller than male significantly.They were (1.81±0.35mm vs 2.01±0.43mm,P<0.05),(1.97±0.52mm vs 2.35±0.55mm, P< 0.05),( 2.32±0.34mm vs 2.72±0.55mm,P<0.05) respectively. Their systolic peak velocites were no significantly difference(P>0.05).3,For the rest 197 cases,There were no significant changes of distal diameters 48～72h after the procedure (1.95±0.41mm vs 1.93±0.39mm,P>0.05),but significant changes in blood velocities of distal radial artery(59.97±20.51cm/s vs 82.56±44.01cm/s, P<0.05). There were no significant changes in intermediate and proxcimal diameters and velocities on this occasion.so was the CR-PWV(9.85±1.57mm vs 9.88±1.61mm, P>0.05).Conclusion1,Transradial intervention is safely in people of this group.Due to double blood-supply,it scarely affect antebrachia blood supply.Even if arterial occlusion , limb anaesthesia and ice cold seldom happened.2,The distal velocity was faster indicated that there was mild stenosis of distal radial artery in 48～72h after transradial coronary intervention. There were no significant changes in other segments of diameters and velocities.3,The diameter of every segment in female were significantly smaller than male.4,There was no significant changes about CR-PWV before and after intervention. It indicated that there was no effect on radial artery elasticity of tansradial intervention in the near future or this meaurment could not reflect injury of endothelium in a short time.Part 2 The effects on diameters,haemodynamics and elasticity of radial artery through transradial coronary interventional procedures 12 weeks laterObjective To evaluate the effects of transradial interventional procedure on diameters,haemodynamics and elasticity of radial artery in a long term.Methods 12 weeks later,133 cases (59.4%) were followed up, including 88 (66.2%)male and 45(33.8%) female patients with average age of 60.29±11.47. According to complicating diseases, they were divided into 5 group: normal group(20),hypertension group (30),hyperlipemia group(32), diabetes group (21),hyperlipemia complicating diabetes group(30). Diameters and blood velocities of the right radial artery were measured with 2-dimensional and color doppler ultrasound on this occasion. At meantime, CR-PWV was measured.Results1,12 weeks later,their total artery was significnat smaller.They were (1.95±0.40mm vs 1.69±0.38mm, P<0.05),(2.25±0.54mm vs 1.96±0.37mm, P<0.05),(2.58±0.59mm vs 2.21±0.45mm,P<0.05),respectively.The blood velocities of distal radial artery is still significantly faster(61.75±15.49cm/s vs 72.30±18.73cm/s,P<0.05).The velocity of intermediate segment(61.01±15.70cm/s vs 65.66±16.45cm/s,P>0.05) and proxcimal segment(59.32±18.48cm/s vs 64.43±16.85cm/s, P>0.05)were normal.2,There were significant changes of all diameters in 21 diabetic patients, 32 hyperlipemia patients and 30 diabetic complicating hyperlipemia patients. So were the distal velocity.But there were no significants changes of 20 normal cases and 30 hypertension cases.3,CR-PWV was significantly lower than preprocedure (9.87±1.52mm vs 9.07±1.37mm,P<0.05).Conclusion1,About 12 weeks later,the total arterial diameter was reduced and distal velocities were faster. This phenomenon occurred more often in patients with hyperlipoidemia (or)and diabetes.2,The artery diameter was smaller 12 weeks later,it indicating that there may be an ongoing intimal hyperplasia process among this period.So use a catheter-exposed radial artery as a conduit in coronry artery revascularization should not be strongly recommended.3,On 12 weeks,CR-PWV reduced significantly,it may related to secondary prevention of coronary heart disease. So taking medicine on time to cut down blood fat,blood presure,serum glucose and improving unhealthy live habit,taking exercises could still considered to be a good method.Part 3 Diagnosis of B-Flow mode and risk factors prediction of acute radial artery occlusion(RAO) following transradial percutaneous coronary interventionObjective To contrast three methods in RAO diagnosis; To evaluate the risk factors of acute RAO following transradial percutaneous coronary intervention.Methods From December,2006 to July,2007,the patients who were underwent transradial coronary intervention were tested with three methods to diagnose RAO:touching pulse, color blood flow display and B-Flow mode in ultrasound in 3 days. All of them were divided into normal group and RAO group according to whether they had RAO.Risk factors of RAO were analyzed by logistic regression model.Results1,34 cases were identified RAO,including 20 (8.6%)cases in part 1. There are 21 male and 13 female patients with average age of 56.00±13.09.2,we found 19 occluded cases by touching pulse, 31 cases with 2-dimensional and color doppler ultrasound ,34 cases by B-Flow mode.Among them, 1 case was misdiagnosed by method two ,the blood flow of 4 cases come from collateral circulation.3,As compared to the patients in normal group,there were more patients whose distal diameters were less than 1.5mm[26(13.41%) vs 12(36.4%),P<0.05] and puncture times were multiple [47(23.9%)vs 20 (59.1%),P<0.05] in RAO group.4,Multiple regression analysis showed that hyperlipem- ia,distal diameter of radial artery less than 1.5mm, times of puncturation were the main determinants for radial artery occlusion.Conclusion1,Ultrasonic diagnosis is better than touching pulse.Color blood flow complicating B-Flow mode reduced missing diagnosis.2,In order to avoid arterial occlusion ,we should examin radial artery carefully with ultrasound before intervention.We recommed transfemoral approach if distal diameter is less than 1.5mm,never puncture the same radial artery, be careful if patients complicating hyperlipemia.