Long-term endothelial dysfunction after trans-radial catheterization: A meta-analytic approach

Background 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. Methods 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 I2. 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. Results 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. Conclusions 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.