Aisha KhalidHarvard Medical School, USA
Title: Contentious suitability of Prior Cannulated Radial artery as a conduit of choice for CABG
Background: Risk of potential damage to the Radial artery (RA) due to cannulation and contrast is not mitigated by sophisticated technology or advanced procedural skillset. We reviewed published literature to probe the effects of trans radial catheterization on Radial artery’s endothelial physiology and suitability as conduit for Coronary artery Bypass Grafting (CABG).
Study design and Method: We searched PubMed and MEDLINE from 1900 till May 2022 to appraise the radial artery occlusion in trans cannulated artery. Applicable studies were selected, and data were extracted. The date was synthesized by quantitative pooling and meta-analysis along with suitable graphic representation. A total of 21 studies were included. Statistical heterogenicity among meta-analysis studies was tested by Cochran’s Q test.
Results and Discussion: The incidence rate of occlusion of RA with prior cannulation is 0.5 to 30 % (1, 2). The pathological changes like Perivascular inflammation, reactive hyperplasia, and damage of tunica media of endothelium secondary to contrast agent, even after 3 months of original procedure makes pre-cannulated radial artery, less favorable conduit for CABG (3). Non-recovery of vasomotor function of endothelium several months after trans radial catheterization may limit the use of RA as conduit in CABG surgery (4). Trans radial catheterization reduces graft patency early on (5) and there was presence of spasm and clots in prior cannulated RA proved by Kamiya et al whereas the incidence of moderate to severe Radial artery spasm usually associated with multiple punctures attempts and usage of large-bore sheath (6, 7).
Conclusion: Radial artery is the graft of choice, after Left internal Mamillary Artery (LIMA) in most big multicenter globally (8). After above mentioned evidence, cardiologist may need to be obligated to avoid RA where possible especially when early CABG is indicated.
Will be updated soon...