Effects of Sheath Injury and Trimetazidine on Endothelial Dysfunction of Radial Artery after Transradial Catheterization


  • Disclosure: We have no commercial associations that might pose a conflict of interest in connection with the submitted articles.

Address for reprints: Dr. Kyoung-Ha Park, Division of Cardiology, Department of Internal Medicine, Hallym University Medical Center, 94–200 Yeongdeungpo-Dong, Yeongdeungpo-Gu, Seoul 150–719, Korea. Fax. 82–2-2639–5829; e-mail: pkhmd@naver.com.


Objective: We evaluated the effects of sheath injury and trimetazidine (TMZ) on endothelial dysfunction of the radial artery (RA) after transradial coronary artery angiography (TRCAG) or transradial percutaneous coronary intervention (TRPCI) with flow-mediated dilation (FMD).

Methods: One hundred twenty patients who underwent TRCAG or TRPCI with either a long 5Fr or 6Fr sheath were randomly assigned to the TMZ group or the control group. Baseline, postsheath injury (<24 hours after sheath injury), and 10-week FMDs were performed.

Results: In all cannulated RAs, the postsheath injury FMDs were significantly lower than the baseline FMDs (P < 0.01). In the control group, the 10-week FMD was significantly lower than the baseline FMD, but no difference was found in the TMZ group (10.4 ± 3.4% vs. 6.3 ± 2.9%, P < 0.01 and 10.1 ± 3.6% vs. 9.2 ± 3.6%, P = 0.09, respectively). Repeated measures ANOVA revealed significant differences in FMD between the TMZ group and the control group (F = 9.87, P < 0.01). Including coronary artery disease, heparin dose during procedure, sheath size, sheath-RA size ratio, sheath indwelling time in RA, RA spasm, repeated RA sheath injury (upsizing from 5Fr to 6Fr), and TMZ use, the multivariate analysis showed that repeated RA sheath injury and TMZ use (OR 7.40, 95% CI 1.42–38.53, P < 0.05, and OR 0.08, 95% CI 0.02–0.30, P < 0.01, respectively) were independent predictors of the decrement of FMD > 50% (ΔFMDbaseline – 10 week > 50%).

Conclusion: Repeated sheath injury negatively influences endothelial recovery after long 6Fr sheath injury to the RA, and TMZ lessens endothelial dysfunction of the RA after radial catheterization. (J Interven Cardiol 2012;25:411–417)