Sheathless Guiding Research Articles

Feasibility and Efficacy of a Novel Sheathless Guiding Catheter Equipped With Peel-Off External Dilator for Percutaneous Coronary Intervention With Distal Radial Approach – A Japanese Multicenter Study

Feasibility and Efficacy of a Novel Sheathless Guiding Catheter Equipped With Peel-Off External Dilator for Percutaneous Coronary Intervention With Distal Radial Approach – A Japanese Multicenter Study

CRT-100.44 Feasibility and Efficacy of a Novel Sheathless Guiding Catheter Equipped With Peel-Off External Dilator for Percutaneous Coronary Intervention With Distal Radial Approach – A Japanese Multicenter Study

CRT-100.44 Feasibility and Efficacy of a Novel Sheathless Guiding Catheter Equipped With Peel-Off External Dilator for Percutaneous Coronary Intervention With Distal Radial Approach – A Japanese Multicenter Study

Initial Experience With a Novel Sheathless Guiding Catheter (Hyperion SheathLess) for Transradial Coronary Intervention.

The Hyperion SheathLess guiding catheter (Asahi Intecc) is a novel guiding system for transradial percutaneous coronary intervention (PCI). Compared with the previous model (SheathLess Eaucath; Asahi Intecc), improvements achieved with the Hyperion SheathLess catheter are a more flexible tip and a smaller outer diameter of the catheter while maintaining the diameter of the inner lumen. The aim of this study was to report our initial experience with this guiding catheter. A total of 127 consecutive patients undergoing transradial PCI using a 6-Fr Hyperion SheathLess guiding catheter (n = 78) or a 7-Fr catheter (n = 49) were analyzed. Procedural success was 99.2%, with 1 patient (0.8%) requiring conversion to femoral access. No patients were noted to have coronary ostial dissection. Doppler ultrasound examination of the radial artery at 30-day follow-up was available in 111 of 127 patients, with 3 patients (2.7%; all 3 patients in the 7-Fr catheter group) found to have radial artery occlusion. Radial spasm occurred in 3 patients (2.4%; all 3 patients in the 7-Fr catheter group). Forearm hematoma occurred in 10 patients (7.9% total; 4 grade-1 patients [3.2%], 5 grade-2 patients [3.9%], and 1 grade-3 patient [0.8%]). The use of the Hyperion SheathLess guiding catheter for transradial PCI was feasible and associated with a low rate of procedure-related complications, including coronary ostial dissection. This sheathless guiding catheter could be a valuable option to further decrease the risk of procedure-related complications.

Sheathless Guiding Catheter from a Femoral Approach for Complex PCI- an Unusual Solution for an Often-Encountered Problem

Sheathless guiding catheters are a valuable tool in the catheterization labor and may assist the operator when dealing with heavily calcifies and tortuous vessels. Nevertheless, when hostile anatomy prevents successful PCI from the radial access, transfemoral use of sheathless guide can assist in overcoming these challenges in a safe manner.

TCTAP A-142 Sheathless Guiding Catheters as a Safe and Effective Alternative to Conventional Guiding Catheters in Patients with Upper Extremities Vascular Anomalies

More effort is directed to improve TRA intervention materials, this achieved by increasing guiding catheter internal diameter while decreasing outer diameter as in sheathless guiding catheter systems. Patients underwent TRA procedures (2006 to 2017) in whom there was any type of upper arm vascular

Transradial Approach for Left Ventricular Endomyocardial Biopsy

BackgroundLeft ventricular endomyocardial biopsy (LV-EMB) may offer a superior diagnostic yield compared with right ventricular endomyocardial biopsy (RV-EMB) in conditions predominantly affecting the LV but is underused compared with RV-EMB. Despite the steep uptake of radial approach in coronary interventions, LV-EMB is usually performed via the femoral artery in contemporary practice. Therefore, the aim of this study was to assess the safety and feasibility of LV-EMB via a transradial approach in a multicentre registry. MethodsOne-hundred and two patients who underwent LV-EMB via transradial approach were included. Clinical characteristics, procedural, safety and feasibility data were evaluated. ResultsLV-EMB was successfully performed via transradial access in 101 (99%) patients. Mild or moderate radial artery spasm occurred in 12 (12%) patients, but only 1 (0.98%) patient required conversion to femoral access due to severe spasm. A total of 80 (78%) patients had LV-EMB via a sheathless guide catheter. Among those, 77 (96.3%) patients had 7.5-French sheathless guides, and 3 (3.8%) patients had 8.5-French sheathless guides inserted. Radial sheaths were used in the remaining 22 patients, with 5-French sheaths in 21 of 22 patients. Heparin was administered to 93.1% of patients at a median dose of 5000 (3000–5000) IU. The remaining patients followed a provisional strategy upon patent hemostasis achievement. No access site-related complications were reported. There were no major complications (pericardial tamponade, life-threatening arrhythmia, cerebrovascular accident or death). ConclusionsIn a population of patients undergoing transradial LV-EMB, the procedural success rate was high and showed an excellent safety profile. Further studies comparing transradial and transfemoral routes may help expand the use of transradial access for LV-EMB.

Technical Considerations in Transradial Unprotected Left Main Stem Rotational Atherectomy-Assisted and IVUS-Guided Percutaneous Coronary Intervention Using the 7.5F Eaucath Sheathless Guiding Catheter System

Rotational atherectomy-assisted percutaneous coronary intervention (PCI) on unprotected left main stem (LMS) bifurcation lesions is technically challenging. Intravascular ultrasound (IVUS) has become a standard part of the PCI procedure for the treatment of LMS disease. There is limited experience in performing these cases via a transradial approach using a sheathless guiding catheter (SGC) system. We report a case of a symptomatic octogenarian patient with restrictive angina and significant LMS bifurcation disease, who was successfully treated transradially with the use of the 7.5F Eaucath SGC system and we describe the technical challenges encountered with this strategy.

TCT-657 The PRAGMATIC Study: A Prospective Randomized Clinical Trial comparing Radial Artery Intimal Hyperplasia resulting from a 7F Sheathless Guide (Mach 1TM) vs. a 6F Transradial Sheath/Guide Combination in Coronary Intervention

TCT-657 The PRAGMATIC Study: A Prospective Randomized Clinical Trial comparing Radial Artery Intimal Hyperplasia resulting from a 7F Sheathless Guide (Mach 1TM) vs. a 6F Transradial Sheath/Guide Combination in Coronary Intervention

P3311A randomized comparison of frequency of radial artery occlusion and radial artery spasm associated with TRI Using 6.5-Fr Sheathless Guide Catheter vs. 6.0-Fr Glidesheath Slender

P3311A randomized comparison of frequency of radial artery occlusion and radial artery spasm associated with TRI Using 6.5-Fr Sheathless Guide Catheter vs. 6.0-Fr Glidesheath Slender

Transradial Sheathless Approach for PCI.

The lumen of the radial artery in many patients is smaller than the outer diameter of a 6F radial sheath frequently leading to procedural pain, trauma to the radial artery and contributing to radial occlusion. Chronically, neointima formation reduces luminal size further, limiting successful re-intervention in some patients. Sheathless guides are 1-2F sizes smaller than corresponding sheaths and so may potentially reduce radial artery trauma. Although not currently recommended for routine use, the 6.5F Asahi EauCath Sheathless guide has a lower profile than a 5F sheath and the same inner lumen as a 6F guide and has been shown to be especially useful for interventional procedures requiring 6F techniques in patients with small radial arteries. Similarly, the 7.5F Asahi EauCath has a lower profile than a 6F sheath and the same inner lumen as a 7F guide and is useful for procedures requiring a large bore guide catheter. Alternatives include the MediKit Works 5F sheathless system and long dilators designed to allow the sheathless introduction of conventional guides. The recently approved 'Flip' dilator is now available outside Japan; however, experience is currently limited.

TCT-282 Feasibility and Safety of Transradial Coronary Intervention Using 6.5 French Sheathless Guiding Catheter during ST-segment Elevation Acute Coronary Syndrome (STEACS) in Patients with Small Radial Artery: A Multi Center Registry.

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.

TCT-411 Use of Sheathless Guide Catheter with Transradial Percutaneous Coronary Intervention: Single Center Experience with 7853 Procedures

TCT-411 Use of Sheathless Guide Catheter with Transradial Percutaneous Coronary Intervention: Single Center Experience with 7853 Procedures

Endovascular Therapy Using a 4.5-Fr Sheathless Guiding Catheter for the Infrapopliteal Artery by the Cross-over Approach

要 旨：2009年4月から2010年5月までの対側大腿動脈アプローチにて膝下動脈病変のみを治療した重症虚血肢の患者15例，17患肢，22病変を対象とした。全例小口径シースレスガイディングカテーテル(Parent Plus45TM)を使用したがすべて患側の膝窩動脈まで挿入でき，病変成功率は95%，初期成功率は100%で，合併症は認めなかった。膝下動脈病変に対する血管内治療の治療戦略として，4.5 Frである小口径シースレスガイディングカテーテル(Parent Plus45TM)を使用し対側大腿動脈アプローチにて行うことは，低侵襲で満足のいく治療法である。

AS-155 Useful of the Sheathless Guide Catheter during Routine Transradial Percutaneous Coronary Intervention

AS-155 Useful of the Sheathless Guide Catheter during Routine Transradial Percutaneous Coronary Intervention

Feasibility of Transradial Coronary Intervention Using a Sheathless Guiding Catheter in Patients With Small Radial Artery

Background and ObjectivesTransradial coronary angiography and intervention are increasing in frequency due to lower major vascular access site complications and the potential for early mobilization. However, the small size of the radial artery (RA) is a major limitation of this technique. A sheathless guiding catheter (GC) has recently been introduced that has a 1-2 French smaller diameter compared with the corresponding introducer sheath. This catheter also has a hydrophilic coating along its entire length. We evaluated the feasibility of using a sheathless GC in patients who have small radial arteries.Subjects and MethodsThe procedural results were evaluated in patients with small radial arteries (diameter <2.3 mm) who underwent transradial coronary intervention using a sheathless GC.ResultsA total of 25 (male: 9) patients with 29 lesions were enrolled. The mean RA diameter was 1.81±0.26 mm. 44% of the patients had stable angina and 50.0% had acute coronary syndrome. The procedural success rate was 93.1%. Two patients (6.9%) had chronic total occlusive lesions that could not be crossed with a guide-wire despite good guiding support. An intravascular ultrasound could be used for all of the treated lesions. Multi-vessel intervention was performed in 29.2% of the patients. Two bifurcated lesions were treated with a kissing balloon technique, and one with a modified T-stenting technique. No catheter related complications were reported.ConclusionThe use of a sheathless GC is feasible in patients with small radial arteries without catheter related complications.

TCT-187: Comparison of Novel Slender (“Virtual 4 French”) 6.5 French Sheathless Guiding Catheter versus 5 French Guiding Catheter for Transradial Coronary Intervention

TCT-187: Comparison of Novel Slender (“Virtual 4 French”) 6.5 French Sheathless Guiding Catheter versus 5 French Guiding Catheter for Transradial Coronary Intervention

Use of the sheathless guide catheter during routine transradial percutaneous coronary intervention: A feasibility study

The aim of this study is to investigate the feasibility of using a 6.5 Fr sheathless guide catheter as a default system in transradial (TRA) percutaneous coronary intervention (PCI). TRA PCI has been shown to reduce mortality rates through a reduction in access site related bleeding complications compared with procedures performed though a femoral approach. Complications associated with the TRA route increase with the size of sheath used. These complications may be reduced by the use of a sheathless guide catheter system (Asahi Intecc, Japan) that is 1-2 Fr sizes smaller in diameter than the corresponding introducer sheath. We performed PCI in 100 consecutive cases using 6.5 Fr sheathless guides to determine the procedural success, rates of symptomatic radial spasm and radial occlusion. Procedural success using the 6.5 Fr sheathless guide catheter system was 100% with no cases requiring conversion to a conventional guide and catheter system. There were no procedural complications recorded associated with the use of the catheter. Adjunctive devices used in this cohort included IVUS, stent delivery catheters, distal protection devices, and simple thrombectomy catheters. The rate of radial spasm was 5% and the rate of radial occlusion at 2 months was 2%. Use of the 6.5 Fr sheathless guide catheter system, which has an outer diameter <5 Fr sheath, as the default system in routine PCI is feasible with a high rate of procedural success via the radial artery.