Impact of Introducer Sheath Coating on Endothelial Function in Humans After Transradial Coronary Procedures

Abstract

Background— The aim of this study was to compare the impact of transradial catheterization with hydrophilic-coated catheter sheaths versus uncoated sheaths on NO-mediated endothelial-dependent and -independent vasodilator function. Methods and Results— Thirty-five subjects undergoing transradial catheterization were recruited and assessed before and the day after catheterization. A subgroup was also assessed 3 to 4 months after catheterization. Subjects received hydrophilic-coated sheaths (n=15) or uncoated sheaths (n=20). Radial artery flow-mediated dilatation and endothelium- and NO-dependent arterial dilatation were assessed within the region of sheath placement. Glyceryl trinitrate endothelium-independent NO-mediated function was also assessed. The noncatheterized arm provided an internal control. Flow-mediated dilatation in the catheterized arm decreased from 10.3�3.8% to 5.3�3.3% and 8.1�2.4% to 5.2�3.7% in the coated and uncoated groups, respectively ( P <0.01). These values returned toward baseline levels ≈3 months later (coated, 6.4�1.4%; uncoated, 9.4�4.1%; P <0.05) versus postprocedure. Glyceryl trinitrate decreased from 14.8�7.2% to 9.5�4.1% ( P <0.05) in the coated group and from 12.2�4.6% to 7.5�4.2% ( P <0.01) in the uncoated group. Values returned to baseline at ≈3 months (coated, 16.6�5.6%; uncoated, 12.1�3.9%; P <0.05). There was no difference in the magnitude of decrease in flow-mediated dilatation or glyceryl trinitrate between coated and uncoated groups. No changes in function occurred in the noncatheterized arm. Conclusions— Placement of a catheter sheath inside the radial artery disrupts vasodilator function, which recovers after 3 months. No differences were evident between hydrophilic-coated and uncoated sheaths.