Arı MEHTAP, Umuttan DOĞAN, Özdemir KURTULUŞ

Radiyal Arter Yolu ile Koroner Anjiyografi Yapılan Hastalarda Uzun Etkili Oral nitrat Kullanımının Radiyal Arter ve Akım Aracılı Dilatasyon Üzerine Etkisinin İncelenmesi

amaç: Radiyal arter yoluyla yapılan koroner anjiyografi ve perkütan koroner anjiyoplasti işlemleri sırasında uzun etkili oral nitrat kullanımının radiyal arter çap ve açıklık oranlarına, aynı taraf brakiyal arter çap ve fonksiyonlarına etkisi ile ilgili veriler kısıtlıdır. Çalışmamızda, bu ilişkilerin incelenmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışmamıza angina pektoris ile başvuran ve yapılan efor testi sonucunda elektif şartlarda radiyal arter yoluyla koroner anjiyografi veya perkütan koroner girişim yapılması planlanan 65 ardışık erişkin hasta alındı. Hastaların işlem öncesi ve sonrası ultrasonografi ölçümleri yapıldı ve akım aracılı dilatasyon oranları hesaplandı. Oral nitrat kullanan ve kullanmayan hastaların ölçümleri karşılaştırıldı. Bulgular: Uzun etkili oral nitrat alımının brakiyal arter çapı ve brakiyal arterde ölçülen akım aracılı dilatasyon üzerine etkisinın bulunmadığı gözlenmiştir. Uzun etkili nitrat kullanımının işlem başarısına ve radiyal arter yolu ile yapılan koroner anjiyografi sonrasında 1. ayda radiyal arter çapları üzerine etkisinin olmadığı gözlenmiştir. Bunun yanı sıra nitrat almayanların aksine nitrat alanlarda işlem sonrası radiyal arter sertliğinde azalma tespit edilmiştir. Sonuç: Uzun etkili nitrat kullanımının radiyal arter yolu ile yapılan koroner anjiyografi sonrasında 1. ayda radiyal arter çapları üzerine etkisinin olmadığı gözlenmiştiri.

Evaluation of Effect of long-Acting Oral nitrates on the Radial Artery and Flow-Mediated Dilatation in patients Undergoing Coronary Angiography

objective: Data regarding effects of long-acting oral nitrates on radial artery diameter, peri- and postoperative vessel patency rates, brachial artery diameters and flow-mediated dilatation parameters in patients undergoing transradial coronary angiography and angioplasty are inconclusive. We aimed to evaluate these relationships in a prospective study. Material and Methods: patients presenting with angina pectoris and a positive treadmill test (n=65) who were referred for elective coronary angiography and angioplasty via radial artery access were included in the study. Ultrasonographic measurements and flow-mediated dilatation tests were done before and after the procedure. The values of the patients with and without oral nitrate therapy were compared. results: There was no effect of long-acting oral nitrates on brachial artery diameter and flowmediated dilatation. Also there was no effect on procedure success and radial artery diameter measured 1 month later. In contrast to patients not taking oral nitrates, radial artery stiffness decreased in patients using oral nitrates. conclusion: long-acting nitrate use did not have any effect on radial artery diameters after the first month in coronary angiography performed via the radial artery.

PDF

___

1. European Association for percutaneous Cardiovascular Interventions (EApCI), Wijns W, Kolh p, Danchin n, Di Mario C, Falk V, Folliguet T, Garg S, Huber K, James S, Knuuti J, lopez-Sendon J, Marco J, Menicanti l, Ostojic M, piepoli MF, pirlet C, pomar Jl, Reifart n, Ribichini Fl, Schalij MJ, Sergeant p, Serruys pW, Silber S, Sousa Uva M, Taggart D. Guidelines on myocardial revascularization. Eur Heart J 2010; 31(20):2501-55.
2. Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, Douglas PS, Foody JM, Gerber TC, Hinderliter AL, King SB 3rd, Kligfield PD, Krumholz HM, Kwong RY, Lim MJ, Linderbaum JA, Mack MJ, Munger MA, Prager RL, Sabik JF, Shaw LJ, Sikkema JD, Smith CR Jr, Smith SC Jr, Spertus JA, Williams SV; American College of Cardiology Foundation; American Heart Association Task Force on Practice Guidelines; American College of Physicians; American Association for Thoracic Surgery; Preventive Cardiovascular Nurses Association; Society for Cardiovascular Angiography and Interventions; Society of Thoracic Surgeons. 2012 ACCF/AHA/ACP/ AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2012; 60(24):44-164.
3. Wakeyama T, Ogawa H, Iida H, Takaki A, Iwami T, Mochizuki M, Tanaka T. Intima-media thickening of the radial artery after transradial intervention. An intravascular ultrasound study. J Am Coll Cardiol 2003; 41:1109-14.
4. Park KH, Park DW, Kim MK, Kim HS, Park WJ, Cho GY, Choi YJ. Effects of sheath injury and trimetazidine on endothelial dysfunction of radial artery after transradial catheterization. J Interv Cardiol 2012; 25(4): 411-7.
5. Uhlemann M, Möbius-Winkler S, Mende M, Eitel I, Fuernau G, Sandri M, Adams V, Thiele H, Linke A, Schuler G, Gielen S. The Leipzig Prospective Vascular Ultrasound Registry in Radial Artery Catheterization Impact of Sheath Size on Vascular Complications, JACC: Cardiovascular Interventions 2012; 5:36-43.
6. Bernat I, Bertrand OF, Rokyta R, Kacer M, Pesek J, Koza J, Smid M, Bruhova H, Sterbakova G, Stepankova L, Costerousse O. Efficacy and safety of transient ulnar artery compression to recanalize acute radial artery occlusion after transradial catheterization. Am J Cardiol 2011; 107:1698-701.
7. Pancholy SB, Patel TM. Effect of duration of hemostatic compression on radial artery occlusion after transradial access. Catheter Cardiovasc Interv 2011; 79:78-81
8. Bots ML, Westerink J, Rabelink TJ, de Koning EJ. Assessment of flow-mediated vasodilatation (FMD) of the brachial artery: effects of technical aspects of the FMD measurement on the FMD response. Eur Heart J. 2005; 26(4):363-8.
9. Green DJ, Jones H, Thijssen D, Cable NT, Atkinson G. Flow-mediated dilation and cardiovascular event prediction does nitric oxide matter? Hypertension 2011; 57(3):363-9.
10. Corretti MC, Anderson TJ, Benjamin EJ, Celermajer D, Charbonneau F, Creager MA, Deanfield J, Drexler H, Gerhard-Herman M, Herrington D, Vallance P, Vita J, Vogel R; International Brachial Artery Reactivity Task Force. Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery: A report of the International Brachial Artery Reactivity Task Force. J Am Coll Cardiol 2002 16; 39(2):257-65.
11. Bahra M, Kapil V, Pearl V, Ghosh S, Ahluwalia A. Inorganic nitrate ingestion improves vascular compliance but does not alter flow-mediated dilatation in healthy volunteers. Nitric Oxide 26(4): 197-202.
12. Kim KS, Park HS, Jung IS, Park JH, Ahn KT, Jin SA, Park YK, Kim JH, Lee JH, Choi SW, Jeong JO, Seong IW. Endothelial dysfunction in the smokers can be improved with oral cilostazol treatment. J Cardiovasc Ultrasound 2011; 19(1):21-5.
13. García RG, Zarruk JG, Barrera C, Pinzón A, Trillos E, Arenas WD, Luengas C, Tomaz C, López-Jaramillo P. Plasma nitrate levels and flow-mediated vasodilation in untreated major depression. Psychosom Med 73(4): 344- 49.
14. Casey DP, Beck DT, Braith RW. Systemic plasma levels of nitrite/nitrate (NOx) reflect brachial flow-mediated dilation responses in young men and women. Clin Exp Pharmacol Physiol 2007; 34(12):1291-3.
15. Vassilakopoulou M, Mountzios G, Papamechael C, Protogerou AD, Aznaouridis K, Katsichti P, Venetsanou K, Dimopoulos MA, Ikonomidis I, Papadimitriou CA. Paclitaxel chemotherapy and vascular toxicity as assessed by flow-mediated and nitrate-mediated vasodilatation. Vascul Pharmacol 2010; 53(3-4): 115-21.
16. Nastri CO, Martins WP, Ferriani RA, Filho FM, Dos FJ. Sonographic evaluation of endothelial function in letrozole and tamoxifen users. Maturitas 2008; 61(4):340-4.
17. Madssen E, Haere P, Wiseth R. Radial artery diameter and vasodilatory properties after transradial coronary angiography. Ann Thorac Surg 2006; 82(5):1698-702.
18. Bouthier JD, Safar ME, Benetos A, Simon AC, Levenson JA, Hugues CM. Haemodynamic effects of vasodilating drugs on the common carotid and brachial circulation of patients with essential hypertension. Br J Clin Pharmacol 1986; 21:137-14.
19. Fitchett DH. Forearm arterial compliance: New measure of arterial compliance? Br J Clin Pharmacol 1986; 21:137-42.
20. Laurent S, Arcaro G, Benetos A, Lafleche A, Hoeks A, Safar M, O'Rourke M. Mechanism of nitrate-induced improvement on arterial compliance depends on vascular territory. J Cardiovasc Pharmacol 1992; 19: 641-9.
21. Simova I, Katova T, Kostova V, Hristova K, Dimitrov N. Reproducibility of arterial stiffness indices in different vascular territories and between different observers. Echocardiography 2011; 28:448-56.
22. Kawasaki T, Sasayama S, Yagi S, Asakawa T, Hirai T. Non-invasive assessment of the age related changes in stiffness of major branches of the human arteries. Cardiovasc Res 1987;21(9):678-87.
23. Westling H, Jansson L, Johnston B, Nilsen R. Vasoactive drugs and elastic properties of human arteries in vivo with special reference to the action of nitroglycerin. Eur Heart J 1984;5:609-16