Antonopoulos Alexios S, Latsios George, Oikonomou Evangelos, Aznaouridis Konstantinos, Papanikolaou Aggelos, Syrseloudis Dimitris, Siasos Gerasimos, Vavuranakis Manolis, Toutouzas Konstantinos, Tousoulis Dimitris
1st Cardiology Department, Hippokration Hospital, University of Athens Medical School, Athens, Greece.
J Card Surg. 2017 Aug;32(8):464-473. doi: 10.1111/jocs.13181.
Following cardiac catheterization using radial artery (RA) access, persistent endothelial dysfunction may limit the use of RA as a conduit during coronary artery bypass graft (CABG) surgery. We reviewed published literature to investigate the effects of transradial coronary catheterization on RA endothelial function.
We searched PubMed from inception to April 2017 for published studies assessing RA endothelial function late (≥1 month) after coronary catheterization. A total of 12 eligible published studies (n = 490 patients) were included in the final quantitative synthesis. Statistical heterogeneity among studies was assessed by the I . A random effects model was used to calculate the pooled estimate for standardized mean difference (SMD). Meta-regression analysis was used to explore predictors of change in RA endothelial function following catheterization.
In all studies, a significant reduction in endothelium dependent response was observed post-catheterization (SMD = -0.53, 95% confidence interval [CI]: -0.93 to -0.13, P = 0.01) and a marginal, non-significant, reduction in endothelium independent response (SMD = -0.38, 95%CI: -0.77, 0.01, P < 0.059). In controlled studies, using the contralateral RA as a control, a significant impairment in endothelial function was confirmed (SMD = -6.26, 95%CI: -9.71 to -2.81, P < 0.0001), while the change in endothelium-independent response was not significant (SMD = -4.46, 95%CI: -13.3 to 4.37, P = 0.32). In meta-regression analysis male gender (z = 2.36, P = 0.018) and increasing time following catheterization (z = 2.62, P = 0.009) were associated with less RA endothelial dysfunction.
Transradial catheterization impairs endothelium dependent vasodilatory properties of the cannulated RA, which do not recover even several months post-catheterization. Non-recovery of vasomotor function of cannulated RAs may limit their use as arterial grafts during CABG surgery.
在采用桡动脉（RA）入路进行心脏导管插入术后，持续性内皮功能障碍可能会限制RA在冠状动脉旁路移植术（CABG）手术中作为血管 conduit 的应用。我们回顾了已发表的文献，以研究经桡动脉冠状动脉导管插入术对RA内皮功能的影响。
我们检索了从数据库建立至2017年4月的PubMed，以查找评估冠状动脉导管插入术后晚期（≥1个月）RA内皮功能的已发表研究。共有12项符合条件的已发表研究（n = 490例患者）纳入最终的定量综合分析。通过I评估研究之间的统计异质性。采用随机效应模型计算标准化均值差（SMD）的合并估计值。采用Meta回归分析探讨导管插入术后RA内皮功能变化的预测因素。
在所有研究中，导管插入术后内皮依赖性反应均显著降低（SMD = -0.53，95%置信区间[CI]：-0.93至-0.13，P = 0.01），内皮非依赖性反应略有降低但不显著（SMD = -0.38，95%CI：-0.77，0.01，P < 0.059）。在对照研究中，以对侧RA作为对照，证实内皮功能有显著损害（SMD = -6.26，95%CI：-9.71至-2.81，P < 0.0001），而内皮非依赖性反应的变化不显著（SMD = -4.46，95%CI：-13.3至4.37，P = 0.32）。在Meta回归分析中，男性（z = 2.36，P = 0.018）和导管插入术后时间增加（z = 2.62，P = 0.009）与RA内皮功能障碍减轻相关。
经桡动脉导管插入术会损害被插管RA的内皮依赖性血管舒张特性，即使在导管插入术后数月也无法恢复。被插管RA的血管运动功能无法恢复可能会限制其在CABG手术中作为动脉移植物的应用。
