Slender Sheath/Guiding Catheter Combination vs. Sheathless Guiding Catheter for Acute Coronary Syndrome: A Propensity-Matched Analysis of the Two Devices.

Tsuyoshi Isawa,Kazunori Horie,Masataka Taguri,Taku Honda,Norio Tada

doi:10.1155/2020/8216831

Tsuyoshi Isawa, Kazunori Horie + Show 3 more

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https://doi.org/10.1155/2020/8216831

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Abstract

A Glidesheath slender (Terumo, Tokyo, Japan) and a sheathless Eaucath guiding catheter (Asahi Intecc, Nagoya, Japan) are two major slender devices utilized in percutaneous coronary intervention (PCI). This study aimed to investigate the differences in access-site complications between these devices in PCI for acute coronary syndrome (ACS). A total of 1108 consecutive patients who underwent transradial PCI for ACS were enrolled. Transradial PCI was performed using either a 7-Fr Glidesheath slender/7-Fr guiding catheter combination (Glidesheath group) or a 7.5-Fr sheathless guiding catheter (Sheathless group); 1 : 1 propensity score matching was performed, and 728 patients (364 in each group) were included in the propensity-matched population. In the matched patients, univariate analysis revealed that the Glidesheath group had less radial artery occlusion (RAO) at 30 days (Glidesheath: 1.4% vs. Sheathless: 4.1%, odds ratio (OR) = 0.33, 95% confidence interval (CI) = 0.12–0.91, p=0.039), whereas no significant between-group differences were observed in severe radial spasm (Glidesheath: 1.4% vs. Sheathless: 1.9%, OR = 0.71, 95% CI = 0.23–2.22, p=0.58) or access-site major bleeding (Glidesheath: 1.4% vs. Sheathless: 1.6%, OR = 0.83, 95% CI = 0.26–2.71, p=1.00). Multivariate analysis revealed that the choice for Glidesheath was significantly associated with less RAO (OR = 0.32, 95% CI = 0.11–0.93, p=0.036). In conclusion, 7-Fr Glidesheath slender/7-Fr guiding catheter combination is obviously more advantageous than 7.5-Fr sheathless guiding catheters for decreased risk of RAO. The potential low risk of RAO in our findings supports the adoption of the 7-Fr Glidesheath slender sheath/7-Fr guiding catheter combination in transradial PCI for ACS.

Highlights

728 patients treated with percutaneous coronary intervention (PCI) using a 7-Fr Glidesheath slender sheath/7-Fr guiding catheter combination or a 7.5-Fr sheathless guiding catheter were included in the matched population (Glidesheath group, n = 364; Sheathless group, n = 364)
The baseline clinical and procedural characteristics were well balanced between the groups, except for the frequency of left circumflex artery lesions, the guiding catheter types used to perform PCI for left anterior descending or diagonal artery, and the rate of thrombus aspiration
In case of exchanging the guiding catheter for a larger/smaller size, more injury to radial artery is not expected in the Glidesheath group; the guiding catheters pass inside the 16 cm-long Glidesheath slender sheath and do not cause more damage to radial artery at the sheath insertion point. erefore, the number of catheters used per procedure may not be related to the radial injury in the Glidesheath group and we did not include it in the multivariate analysis to determine predictors of radial artery occlusion (RAO)

Summary

Introduction

E outer diameters of the 7.5-Fr sheathless guiding catheter and the 7-Fr Glidesheath slender are smaller than, or almost equal to, that of the conventional 6-Fr sheath, which is currently used as the mainstream sheath in transradial PCI. No previous study has compared the 7-Fr Glidesheath slender/7-Fr guiding catheter combination with the 7.5-Fr sheathless guiding catheter in terms of the access-site complications in a large sample of patients with ACS treated with transradial PCI. Erefore, we aimed to investigate the differences between the 7-Fr Glidesheath slender sheath/7-Fr guiding catheter combination and 7.5-Fr sheathless Eaucath guiding system in terms of access-site complications in transradial PCI for ACS, using propensity score matching analysis

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