Drug-Eluting Introducer Sheath Prevents Local Peripheral Complications

Hemetsberger, Rayyan; Pósa, Anikó; Farhan, Serdar; Hemetsberger, Hani; Redwan, Bassam; Pávó, Noémi; Pávó, Imre; Plass, Christian; Petneházy, Örs; Petrási, Zsolt; Huber, Kurt; Glogar, Dietmar; Maurer, Gerald; Gyöngyösi, Mariann

doi:10.1016/j.jcin.2010.09.018

Cited by 10 publications

(6 citation statements)

References 18 publications

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“…The dose of 500 µg nitroglycerin would have achieved a maximal vasodilatory effect and expected to decrease the intimal inflammation and intimal hyperplasia of the radial artery. This would be analogous to the findings from a nitric oxide‐coated sheath that was shown to decrease intimal inflammation, intimal hyperplasia, and luminal thrombosis in a porcine model . It is hypothesized that 500 µg of nitroglycerin would make a vasodilation dominancy (through nitrous oxide) in the endothelium of the radial artery that would pharmacologically enhance flow, supporting a higher level of patency to preserve the radial artery during a hemostasis compression.…”

Section: Discussionmentioning

confidence: 56%

A novel approach to reduce radial artery occlusion after transradial catheterization: Postprocedural/prehemostasis intra‐arterial nitroglycerin

Dharma

Kedev

Patel

et al. 2014

Cathet Cardio Intervent

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Section: Discussionmentioning

confidence: 56%

A novel approach to reduce radial artery occlusion after transradial catheterization: Postprocedural/prehemostasis intra‐arterial nitroglycerin

Dharma

Kedev

Patel

et al. 2014

Cathet Cardio Intervent

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“…A new nitric oxide-coated sheath was recently shown to decrease intimal inflammation, intimal hyperplasia, and luminal thrombosis in a porcine model. 55 A group in Korea is evaluating the effect of statins on radial intima-media thickness after transradial PCI (ClinicalTrials.gov identifier No. NCT00952770).…”

Section: Future Directionsmentioning

confidence: 99%

Radial Artery Patency After Transradial Catheterization

Kotowycz

Džavík

2012

Circ: Cardiovascular Interventions

180

133

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T he transradial approach to cardiac catheterization has many advantages over the transfemoral approach and is increasingly being used for both diagnostic coronary angiography and percutaneous coronary intervention (PCI). The technique is associated with fewer vascular access complications [1][2][3] and has been shown to reduce major bleeding when compared with the femoral approach. 4 Patients prefer the radial approach and score higher on quality-of-life questionnaires after transradial catheterization. 3,5 Radial access allows for earlier patient ambulation and same-day hospital discharge in PCI patients 4 -6 and is associated with decreased cost. 5,7,8 Radial artery occlusion (RAO) is a complication of transradial catheterization that can lead to permanent occlusion of the radial artery. Estimated to occur in 1-10% of cases, 9 -14 it has been described as the "Achilles' heel" of the transradial technique. 15 RAO is usually clinically silent because of the dual blood supply to the hand, and for this reason it is often overlooked. In fact, more than 50% of transradial operators do not routinely assess radial artery patency before hospital discharge. 16 However, the complication is not benign, as hand ischemia resulting from RAO has been reported. [17][18][19] Furthermore, once the artery is occluded, it cannot be used as an access site for future catheterization or as an arterial conduit for bypass surgery. RAO renders the ipsilateral ulnar artery unusable as well, because instrumenting and cannulating the ulnar would put the patient's hand at risk of ischemia. In this report, we review the pathophysiology, clinical presentation, and risk factors for RAO, discuss prevention and treatment options, and suggest directions for future research aimed at minimizing this complication. PathophysiologyAcute loss of radial artery patency after cardiac catheterization is thought to be due to a thrombotic process. Sheath insertion leads to local endothelial injury and cessation of blood flow in the radial artery, creating an environment conducive to thrombosis. Many observations about RAO provide indirect evidence to support this hypothesis. RAO tends to occur early after transradial catheterization, and roughly 50% of patients have spontaneous recanalization of the artery within 1-3 months. 10,12 Furthermore, rates of RAO are higher with prolonged cannulation times, 20 -22 whereas RAO is reduced with anticoagulation 23 and nonocclusive hemostasis. 11,24,25 Direct support for the thrombotic hypothesis has come from recent studies that have confirmed the presence of radial artery thrombus on vascular ultrasound, 26 angiography, 27 and pathology. 28 Transradial catheterization can also negatively affect radial artery structure and function. A study using optical coherence tomography found that 67% of radial arteries had intimal tears and 36% had medial dissections immediately after transradial PCI. 29 Other studies have found that minimal lumen diameter and minimal lumen area are smaller in repeat transradial patients than i...

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“…Polymer coating formulation for NO delivery is an active area of research, including applications in extracorporeal circuits and catheters for intravascular/indwelling use . Further, a NO eluting sheath has already provided positive results in an animal study . However, this study appears to ignore some lessons from the existing coatings used clinically, such as the positive patient response to hydrophilic coatings and the potential for fragments of the coating to remain in the body and illicit an immune response .…”

Section: Nanomedicine: a New Therapeutic Paradigmmentioning

confidence: 99%

“…154 Further, a NO eluting sheath has already provided positive results in an animal study. 155 However, this study appears to ignore some lessons from the existing coatings used clinically, such as the positive patient response to hydrophilic coatings 92 and the potential for fragments of the coating to remain in the body and illicit an immune response. 103 Thus, a novel catheter and sheath coatings should remain hydrophilic and ideally be biodegradable or, at least, form a single, thin, well-bonded layer.…”

Section: Functional Coatingsmentioning

confidence: 99%

Cardiac catheterization: consequences for the endothelium and potential for nanomedicine

Sobolewski

Fray

2014

WIREs Nanomed Nanobiotechnol

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Cardiac catheterization results in interactions between the catheter and surfaces and the artery lumen, which is lined by the endothelium. These interactions can range from minor rubbing to severe mechanical injury. Further, in the case of radial access, even atraumatic interactions have consequences ranging from clinical complications, such as radial spasm and radial occlusion, to lasting endothelial cell dysfunction. These consequences may be underappreciated; however, endothelial cells play a central role in maintaining vascular homeostasis via nitric oxide production. Existing treatment paradigms do not address endothelial dysfunction or damage and, thus, novel therapeutic approaches are needed. Nanomedicine, in particular, offers great potential in the form of targeted drug delivery, via functionalized coatings or nanocarriers, aimed at increased nitric oxide bioavailability or reduced inflammation.

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Drug-Eluting Introducer Sheath Prevents Local Peripheral Complications

Abstract: Nitric oxide coating on the introducer sheath prevents local complications during PCI and results in less vascular thrombosis and inflammation at the access site, contributing to patency of the access vessel with similar size to the radial artery.

Cited by 10 publications

References 18 publications

A novel approach to reduce radial artery occlusion after transradial catheterization: Postprocedural/prehemostasis intra‐arterial nitroglycerin

A novel approach to reduce radial artery occlusion after transradial catheterization: Postprocedural/prehemostasis intra‐arterial nitroglycerin

Radial Artery Patency After Transradial Catheterization

Cardiac catheterization: consequences for the endothelium and potential for nanomedicine

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