Abstract
Background: Transradial approach during STESCA is used more frequently and is associated with reduced rate of vascular complications and mortality. However, the small size of the radial artery is sometimes a limitation of this technique. A sheathless guiding catheter is available which is 2 french smaller than the sheath and has a hydrophilic coating along its entire length. The aim of this study is to investigate the feasibility and the safety of using this sheathless catheter during STEACS treatment in patients with small radial arteries. Methods: From March 2009 to May 2013 in three french hospitals, 40 patients had a primary PCI through transradial approach using sheathless catheter after failure to introduce 6F sheath or severe frictions with 5F angiography catheter. Results: The 40 patients were 65.62 16.41 years old (40 to 91), 23 were women (57.5%). Patient baseline characteristics: 10 (25%) had a history of coronary artery disease, 18 (45%) were heavy smokers, hyperlipidaemia in 20 (50%), 15 (37.5%) had hypertension, diabetes in 7 (17.5%) and coronary family history in 5 (12.5%) patients. 12 (30%) patients had a lesion in the LAD, 22 (55%) in the RCA and 6 (15%) in the circumflex coronary artery. The average volume of product of contrast is 128.55 ml . The total number of 49 stents were used used during these procedures (20 BMS, 29 DES) with 1.2 stents/patient. Door to Balloon average time was 35.25 minutes and the procedural time was 47.64 minutes. Adjunctive devices used in this cohort included thrombus-aspiration catheters in 32 patients (80%) and the technique of kissing balloon in 7 patients (17,5%) undergoing bifurcation PCIs. One patient had an acute intra stent thrombosis treated with thromboaspiration then angioplasty with balloon only. Rotablator atherectomy was implemented in one patient for very calcified lesion. The technical success rate of the procedures using the sheathless catheter was 100% without any conversion to femoral approach. There were no radial artery site complications. Conclusions: The use of sheathless guiding catheter safely increases the feasibility of transradial approach for primary PCI.
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