Mini‐invasive strategy in acute coronary syndromes: Direct coronary stenting using 5 Fr guiding catheters and transradial approach

Abstract

The purpose of this study was to assess the feasibility and safety of direct coronary stenting in acute coronary syndromes using 5 Fr guiding catheters by transradial approach. A series of 119 patients with an acute coronary syndrome (unstable angina, n = 55; acute myocardial infarction, n = 45; recent acute myocardial infarction, n = 19) explored by transradial approach and eligible for direct stenting were included. A large proportion of patients (52%) was treated during the procedure by platelet IIb/IIIa receptor blockade. Only Medtronic 5 Fr guiding catheters were used in this study. Direct coronary stenting was attempted in all 119 highly selected patients. Failure of direct stenting was observed in only five cases (3.9%) and the stent successfully retrieved in each case in the 5 Fr guiding catheter. In these five cases, balloon predilation was performed and then the stent implanted successfully. Different stents were used: ACS stent (54%), AVE stent (33%), Velocity stent (10%), Nir stent (3%), with diameter ranging from 2.5 to 4 mm. In four cases, the dilation was finally performed using 6 Fr guiding catheters because the backup of the 5 Fr catheter was considered to be too low (3%). No vascular access site complications occurred in this series of patients. We conclude that direct coronary stenting using transradial approach and 5 Fr guiding catheters yields excellent procedural success rate. In the setting of acute coronary syndromes requiring platelet IIb/IIIa receptor blockade or after failure of thrombolysis, this mini-invasive strategy is very attractive because of the low risk of access site complications.

A Randomized Comparison of Transradial Versus Transfemoral Approach for Coronary Angiography and Angioplasty

“…In our study, the occurrence of groin complications after transfemoral catheterization could be limited to 3.71%. Like other authors (2,4,18,19), we could confirm the low rate of entry site complications using the transradial approach, as indeed only 3 local complications (0.58%) were found in 512 patients. The radial artery is easily compressible due to its superficial course, achieving adequate hemostasis only with a bandage.…”

Direct coronary stenting by transradial approach: Rationale and technical issues

“…Moreover, when a strategy of deep cannulation is planned, the softer tip of 5 Fr guiding catheters may reduce the risk of catheter-induced coronary dissections. On the other hand, even in expert hands, the 5 Fr catheters do not offer sufficient backup for coronary stenting and shifting to 6 Fr ones may be necessary to complete some procedures (in a single-center registry, shifting to larger catheters has been successfully performed in 3% of patients initially approached by 5 Fr [16]). After correct cannulation of the coronary artery with the guiding catheter, DS may be performed by radial approach in the same way as by femoral.…”

“…Indeed, it combines the potential advantages of DS, which shortens the procedural times and possibly improves the early clinical outcome, and those of the radial approach, which allows early ambulation and reduces vascular access site complications. In selected patients with acute coronary syndromes, with both ST elevation myocardial infarction and non-ST elevation myocardial infarction or unstable angina, the adoption of DS by radial approach may reduce the likelihood of distal embolization and limit the hemorrhagic complications [15][16][17] related to the administration of IIb/IIIa inhibitors, thrombolytic drugs, heparins, etc.…”

Radial artery access for coronary angiography and percutaneous coronary intervention

“…By contrast, the pressure wire, intravascular ultrasonography, individual stents, and the “kissing balloon” technique for the treatment of bifurcations can all be accommodated by modern 6 Fr guide catheters such that the ability to manage complex coronary anatomy with these catheters is well established. Indeed, high procedural success rates have now been reported for transradial PCI using 5 Fr guide catheters in selected patients 23 24…”