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

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 approximate to 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 approximate to 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. (Circ Cardiovasc Interv. 2010;3:148-156.)