Feasibility and efficacy of a novel 6 french sheathless guiding catheter equipped with peel-off type external dilator for PCI with distal radial approach - a Japanese multicenter study

Abstract

Abstract Introduction Recently, distal radial access has emerged as a promising alternative access to minimize access site complications. Objectives The aim of this study was to evaluate feasibility and efficacy of a novel 6-Fr sheathless guiding catheter system equipped with peel off type outer dilator for the patients who underwent percutaneous coronary intervention through distal radial artery. Methods Between Oct 2018 and January 2023, a total of 168 patients including 27 patients with ST elevation myocardial infarction underwent percutaneous coronary intervention using a 6-Fr novel sheathless guiding catheter in 2 Japanese hospitals with distal radial approach. The guiding catheter system include a 6-Fr guiding catheter and an inner and outer (peel-off type)dilater to prevent potential vascular damage during passage of the tip of the catheter. After puncture of the distal radial artery with 22 gause needle, a 0.025 inch guidewire with 220 cm length was inserted. Then, a seathless guiding catheter system equipped with both inner and outer sheath was advanced through skin surface for dilatation of puncture point. After peeling off the outer sheath, the catheter with inner sheath was advanced. Hemostatic method complies compression with a hemostatic pad and elastic bandage for 3 hours. Procedural success, bleeding complication and radial occlusion examined using Doppler ultrasound at discharge was accessed. Results Mean age of the patients was 72.1 ± 11.3 years old and 114 patients were male. Procedural success was 100 % with no patient requiring conversion to conventional radial access. The culprit lesion was located in the right coronary artery in 45 patients, the left anterior descending artery in 86 patients, the left circumflex artery in 21 patients, and the left main trunk in 12 patients. Doppler ultrasound examination of the distal radial artery at 1-day follow-up was available in all patients, with 2 patients (1.2%) was found to have radial artery occlusion. One patient (0.6%) presented forearm hematoma equivalent to EASY hematoma classification I and 4 patients (2.4%) showed dorsum hematoma. Conclusions The current study demonstrated that the use of a novel sheathless guiding catheter with outer dilator for distal radial approach in PCI was feasible and may contribute further reduction of procedure-related complications.peel-off type outer dilaterinsertion procedure