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Unsuitability of the radial artery as a bypass conduit after trans radial coronary angiogram
indian heart journal 68 (2016) 181
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/ihj
Research Letter
Unsuitability of the radial artery as a bypass conduit after trans radial coronary angiogram Keywords: Radial artery Angiogram Bypass conduit
I read with interest the excellent article by Satheesh et al.1 and commend them on the details that they have provided. I would like to stress that even with the best technique, hardware and skills the incidence of early complete radial artery (RA) occlusion after prior cannulation has been shown to be between 5% and 20%.2 Also, apart from occlusion, there can be damage to the arterial wall, endothelial disruption, damage of the tunica media, perivascular inflammation, and reactive hyperplasia with impaired vasodilatory capacity even up to 3 months after trans radial catheterization.3,4 The RA – unilateral and bilateral – is being increasingly used as an alternate arterial conduit in coronary artery bypass grafting (CABG) with excellent results. It is the graft of choice in some centers after the left internal mammary artery (LIMA ).5 However because of the changes mentioned above after a trans radial catheterization the cannulated RA may not be a suitable conduit for CABG. Quite alarmingly, Kamiya et al.6 in the only study of this type to date, were able to demonstrate a significantly reduced patency rate for previously punctured RA grafts. We have noted the presence of spasm and clots in prior cannulated RA making them unsuitable for use as conduits.7 It thus behooves the cardiologist to possibly avoid the RA route in patients where there is a strong possibility of the need for early post angiogram CABG. I once again congratulate the authors for their detailed and lucid description of the correct technique of trans radial coronary angiography.
Conflicts of interest The author has none to declare.
references
1. Satheesh S, Subramanian A. How to do radial coronary angiogram. Indian Heart J. 2015;67:170–174. 2. Stella PR, Kiemeneij F, Laarman GJ, et al. Incidence and outcome of radial artery occlusion following transradial artery coronary angioplasty. Cathet Cardiovasc Diagn. 1997;40:156–158. 3. Dawson EA, Rathore S, Cable NT, Wright DJ, Morris JL, Green DJ. Impact of introducer sheath coating on endothelial function in humans after transradial coronary procedures. Circ Cardiovasc Interv. 2010;3:148–156. 4. Gaudino M, Leone A, Lupascu A, et al. Morphological and functional consequences of transradial coronary angiography on the radial artery: implications for its use as a bypass conduit. Eur J Cardiothorac Surg. 2015;48:370–374. 5. Tatoulis J, Wynne R, Skillington PD, Buxton BF. Total arterial revascularization: achievable and prognostically effective—a multicenter analysis. Ann Thorac Surg. 2015;100:1268–1275. 6. Kamiya H, Ushijima T, Kanamori T, et al. Use of the radial artery graft after transradial catheterization: is it suitable as a bypass conduit? Ann Thorac Surg. 2003;76:1505–1509. 7. Bedi HS, Joseph A, Gupta , Tewarson V. Unsuitability of the radial artery after trans radial coronary angiography. Indian Heart J. 2011;6:497.
Harinder Singh Bedi Head, Dept of Cardio Thoracic & Vascular Surgery, Christian Medical College & Hospital, Ludhiana 141008, Punjab, India E-mail address: [email protected] Available online 13 January 2016
http://dx.doi.org/10.1016/j.ihj.2015.10.376 0019-4832/ # 2015 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/ihj
Research Letter
Unsuitability of the radial artery as a bypass conduit after trans radial coronary angiogram Keywords: Radial artery Angiogram Bypass conduit
I read with interest the excellent article by Satheesh et al.1 and commend them on the details that they have provided. I would like to stress that even with the best technique, hardware and skills the incidence of early complete radial artery (RA) occlusion after prior cannulation has been shown to be between 5% and 20%.2 Also, apart from occlusion, there can be damage to the arterial wall, endothelial disruption, damage of the tunica media, perivascular inflammation, and reactive hyperplasia with impaired vasodilatory capacity even up to 3 months after trans radial catheterization.3,4 The RA – unilateral and bilateral – is being increasingly used as an alternate arterial conduit in coronary artery bypass grafting (CABG) with excellent results. It is the graft of choice in some centers after the left internal mammary artery (LIMA ).5 However because of the changes mentioned above after a trans radial catheterization the cannulated RA may not be a suitable conduit for CABG. Quite alarmingly, Kamiya et al.6 in the only study of this type to date, were able to demonstrate a significantly reduced patency rate for previously punctured RA grafts. We have noted the presence of spasm and clots in prior cannulated RA making them unsuitable for use as conduits.7 It thus behooves the cardiologist to possibly avoid the RA route in patients where there is a strong possibility of the need for early post angiogram CABG. I once again congratulate the authors for their detailed and lucid description of the correct technique of trans radial coronary angiography.
Conflicts of interest The author has none to declare.
references
1. Satheesh S, Subramanian A. How to do radial coronary angiogram. Indian Heart J. 2015;67:170–174. 2. Stella PR, Kiemeneij F, Laarman GJ, et al. Incidence and outcome of radial artery occlusion following transradial artery coronary angioplasty. Cathet Cardiovasc Diagn. 1997;40:156–158. 3. Dawson EA, Rathore S, Cable NT, Wright DJ, Morris JL, Green DJ. Impact of introducer sheath coating on endothelial function in humans after transradial coronary procedures. Circ Cardiovasc Interv. 2010;3:148–156. 4. Gaudino M, Leone A, Lupascu A, et al. Morphological and functional consequences of transradial coronary angiography on the radial artery: implications for its use as a bypass conduit. Eur J Cardiothorac Surg. 2015;48:370–374. 5. Tatoulis J, Wynne R, Skillington PD, Buxton BF. Total arterial revascularization: achievable and prognostically effective—a multicenter analysis. Ann Thorac Surg. 2015;100:1268–1275. 6. Kamiya H, Ushijima T, Kanamori T, et al. Use of the radial artery graft after transradial catheterization: is it suitable as a bypass conduit? Ann Thorac Surg. 2003;76:1505–1509. 7. Bedi HS, Joseph A, Gupta , Tewarson V. Unsuitability of the radial artery after trans radial coronary angiography. Indian Heart J. 2011;6:497.
Harinder Singh Bedi Head, Dept of Cardio Thoracic & Vascular Surgery, Christian Medical College & Hospital, Ludhiana 141008, Punjab, India E-mail address: [email protected] Available online 13 January 2016
http://dx.doi.org/10.1016/j.ihj.2015.10.376 0019-4832/ # 2015 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.