Radial arter yoluyla yapılan koroner anjiyografi de girişim sonrası erken dönemde endotel fonksiyonları bozulur, sol distal radial arter yoluyla yapılan girişimlerde radial arter endotel fonksiyonları sağ ve sol konvasyonel yolla yapılan girişimlere kıyasla korunmaktadır.
Radial arter yoluyla yapılan koroner anjiyografide girişim sonrası uzun dönemde sol, sol distal ve sağ radial gruplarında endotel fonksiyonları bazal seviyelere yaklaşmaktadır.
Transradial koroner anjiyografi, komplikasyonları nadir görülen bir yöntem olmakla birlikte sol distal radial arter yoluyla yapılan koroner anjiyografi vazospasm,oklüzyon, major kanama, hematom riski az olan güvenilir bir anjiyografi yöntemidir.
Sol distal radial koroner anjiyografinin işlem konforu yüksek, günlük aktiviteyi bozan ağrılara sebep olma oranı düşük, hastaların yüksek oranda memnun kalıp yakınlarına önerebildiği bir koroner annjiyografi girişim yöntemidir.
ÖZET
TRANSRADĠAL KORONER ANJĠYOGRAFĠDE RADĠAL ARTER ENDOTEL FONKSĠYONLARININ DEĞERLENDĠRĠLMESĠ
GiriĢ ve Amaç: Koroner anjiyografi ve girişimler için yeni bir yöntem olan transradial yaklaşımın yakın zamanda popülaritesini artırmıştır. Ancak transradial koroner anjiyografiden sonra endotel disfonksiyonu gelişebilmektedir.
Bu çalışmada üç farklı radyal giriş bölgesi olan sağ önkol radial arter, sol önkol radial arter ve sol distal radial arterde akım aracılı vazodilatasyon testi ile endotelyal fonksiyonları ve en güvenilir girişi yerini araştırmayı amaçladık.
Metod: 6 Eylü l2017- 6 Mart 2018 tarihleri arasında koroner anjiyografi planlanan 70 hastaya prospektif olarak transradial girişim yapıldı. Hastalar üç gruba ayrıldı: Grup 1 sol önkol radial (17 hasta), grup 2 sol distal radial (27 hasta) ve grup 3 sağ önkol radial arter (26 hasta) girişim yapılanlar.
Akım aracılı endotel fonksiyonları 3 kez ölçüldü; işlem öncesi, işlemden 24 saat sonra ve 2 ay sonra.Test, hasta sırtüstü pozisyonda ve 5 dakika boyunca rahatladıktan sonra yapıldı.Radial arter çapı ölçümünde GE Healthcare Vivid E9 4D kardiyovasküler ultrason sistem cihazı, 11L-D, 4.5-12 MHz lineer probu kullanıldı.Manşon 220 mmHg'ye kadar şişirildi, şişik vaziyet 5 dakika boyunca sürdürüldü.Manşon söndürüldükten sonra radial arter çapı ve yüzdelik değişimi 1., 2. ve 3. dakikada kaydedildi. Tüm veriler IBM SPSS Statistics 21.0 programı ile değerlendirildi. Değişkenlerin karşılaştırılmasında Kruskal Wallis testi ve Anova testi yapıldı.
Bulgular: Yaş ortalaması 58,8 (± 12,3) olup erkek cinsiyet ağırlıktaydı 48 (% 68, 5) ve hipertansiyon 54 (% 77,1), diyabet 28 (% 40) en sık risk faktörleriydi.
Akım aracılı vazodilatasyon testinde radyal arter çapları ve yüzde değişim maksimum seviyesine ilk dakikasında ulaşmıştır. İlk 24 saatte sol distal girişim grubunda sağ radial girişim (p <0,001) ve sol radial girişim grubuna göre endotel fonksiyonu korunmuştur (p <0,001). p = 0,043). Bu işlem işlemden 2 ay sonra devam etti.
Hastalarda radial arter trombozu 6 (% 8,6), ekimoz 4 (% 5,7) ve radial arter oklüzyonu 2 (% 2,9) olarak görüldü, ancak 3 grup arasında istatistiksel olarak
(ekimoz) görüldü. Floroskopi ve stent implantasyonu açısından 3 grup arasında istatistiksel olarak anlamlı fark yoktu.
Sonuç: Radyal arter endotelyal fonksiyonu ilk 24 saatte bozulurken, endotel fonksiyonu sağ- sol konvansiyonel yöntemlerle yapılan girişimlere kıyasla sol distal yöntemle yapılan girişimler ile korunmaktadır. Uzun dönem takiplerde endotel disfonksiyonu azalmaktadır.
Sol distal radial girişim, arteriyel vazospazm, oklüzyon, majör kanama, hematom riski daha az olan güvenilir bir anjiyografi girişim yöntemidir.
Sol distal radial koroner anjiyografi, hastaların yüksek oranda memnun kaldığı ve yakınlarına önerdiği, tedavi konforunun yüksek olduğu ve günlük aktiviteyi bozan ağrıya sebep olma olasılığı düşük olan bir koroner anjiyografi yöntemidir.
Anahtar Kelimeler: Transradial koroner anjiyografi; Endotel fonksiyonu; Akım aracılı dilatasyon testi.
SUMMARY
EVALUATION OF RADIAL ARTERY ENDOTHELIAL FUNCTIONS IN TRANSRADIAL CORONARY ANGIOGRAPHY
Introduction and Aim: Transradial as a new method for coronary angiography and interventions has recently increased its popularity.But endothelial dysfunction may occur after transradial coronary angiography.
We aimed in this study to investigate the endothelial functions and the most reliable intervention through flow mediated vasodilatation test in three different radial access sites: right forearm radial artery, left forearm radial artery and left distal radial artery.
Method: Transradial access was used in 70 patients scheduled for coronary angiograpghy and intervention from September 6-th 2017 and March 6-th 2018, prospectively.They were divided into 3 groups: group 1 left forearm radial (17 patients), group 2 left distal radial (27 patients) and group 3 right forearm radial artery (26 patients) access.
Flow mediated endothelial functions were measured 3 times; on admission, 24 hour after and 2 months after the procedure. The test was performed with the patient supine, relaxed for 5 minutes. GE Healthcare Vivid E9 4D Cardiovascular ultrasound system instrument, 11L-D, 4.5-12 MHz linear probe was used for radial artery diameter measurement.
Arm cuff inflation till 220 mmHg lasted for 5 minutes. After deflation radial artery diameter and their percantage change was recorded in the 1.st, 2nd and 3rd minute. All the data was evaluated by the IBM SPSS Statistics 21.0 programme. Kruskal Wallis test and Anova test was performed for comparison of variables.
Results: Mean age was 58,8(±12,3) with male predominance 48(68%,5) and hypertension 54(77,1%), diabetes 28(40%) were the most common risk factors.
Radial artery diameters and percent change reached the maximum level in the first minute of flow-through dilation test.In the first 24 hours endothelial function is preserved in left distal radial intervention group compared to right radial intervention group(p<0,001) and left radial intervention group(p=0,043).This preservation continoued at 2 months after the procedure.
Radial artery thrombosis 6(8,6%),ecchymosis 4(5,7%) and radial artery occlusion 2(2,9%) were seen in patients but there was no statistical difference between the 3 groups. Only one complication(ecchymosis) was seen in the left distal radial artery access site.There was no statistically significant difference between the 3 groups at the time of fluoroscopy and stent implantation.
Conclusion: The radial artery endothelial function is impaired in the first 24 hours but endothelial function is protected by the attempts made in the distal left access compared to the attempts made by the method right-left konvansiyonel. Endothelial dysfunction is reduced in long term follow-up.
Left distal radial access is a reliable method of angiography intervention with less risk of arterial vasospasm, occlusion, major bleeding, hematoma.
Left distal radial coronary angiography is a method of CAG procedure in which patients are highly satisfied and can recommend to their relatives because the treatment comfort is high and the rate of causing pain that disturb daily activity is low.
Keywords: Transradial coronary angiography; Endhotelial function; Flow mediated dilatation test.
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