Sheathless Guide Catheter Safe, Effective in Transradial Primary PCI

Use of a sheathless guide catheter during transradial primary PCI is safe and effective, according to findings published online September 10, 2015, ahead of print in Catheterization and Cardiovascular Interventions. Additionally, the approach does not increase door-to-balloon and fluoroscopy times beyond what has been seen with conventional catheters.

Masaki Miyasaka, MD, of Sendai Kousei Hospital (Sendai, Japan), and colleagues performed transradial PCI using a sheathless guide catheter (Asahi Sheathless Eaucath Guiding Catheter; Asahi Intecc; Nagoya, Japan) in 478 STEMI patients (median age 67 years; 21.7% women) at their hospital between September 2010 and May 2013.

The left radial approach was employed in all but 5 patients, and 6.5-Fr and 7.5-Fr sheaths were used in 150 and 328 patients, respectively. Median patient BMI was 24.0 kg/m².

The primary endpoint of procedural success—defined as TIMI flow 2 or 3 at the end of the procedure with a stenosis of less than 30% in the culprit lesion and no access site crossover—was achieved in 97.5% of patients. Reasons for procedural failure included incomplete reperfusion due to distal embolization in 9 patients, failure to cross the culprit lesion with a wire in 2, and crossover to the femoral artery due to inadequate backup support for a complex lesion in 1. However, no patients developed radial artery spasm requiring access site crossover.

Median door-to-balloon time was 45 minutes, median fluoroscopy time was 16.4 minutes, and median contrast volume was 134 mL.

Of the 370 patients who had transradial coronary procedures 10 days to 12 months after primary PCI, 3.8% reported complications involving the radial arteries, including stenosis and occlusion. Other complications during subsequent procedures were catheter-induced coronary artery dissection (n = 1), psedoaneurysm of the radial artery requiring surgical closure (n = 1), and bleeding from the puncture site requiring blood transfusion (n = 1). There were no instances of arteriovenous fistula or ischemic limb requiring surgery.

Hydrophilic Coating, Transradial Experience Tied to Procedural Success

Although previous research has shown encouraging results for sheathless guide catheters during transradial PCI, the population of STEMI patients in these studies has been low, Dr. Miyasaka and colleagues note. “[The current] findings suggest that procedural success can be anticipated without increasing door-to-balloon or fluoroscopy time in centers where a sheathless guide catheter is used routinely,” they write.

The access site crossover rate observed here was “much lower than [the 1.8-9.6% incidence] seen in previous studies on transradial PCI using a conventional guide catheter,” the authors state.

Earlier reports identified inadequate puncture, radial artery spasm, peripheral occlusion, and inadequate guide catheter support as common causes of crossover, they note. In contrast, the sheathless catheter’s hydrophilic coating “minimizes friction between the catheter and the surrounding tissues” reducing the likelihood of such problems, the investigators write.

Another factor responsible for the minimal crossover rate may be the predominant use of left radial access, which has been previously shown to be technically easier than right side access given less tortuosity in the left subclavian artery,  they authors say.

A further advantage of the sheathless catheter is that it overcomes the size limitations imposed by conventional catheters. The latter require introducer sheaths and guide catheters, whereas sheathless catheters allow a greater range of options in the treatment of complex lesions, Dr. Miyasaka and colleagues observe.  

However, they caution, their center’s high level of experience with transradial PCI—and its operators’ comfort level with the approach—should be taken into account in interpreting the results.

Source: 
Miyasaka M, Tada N, Kato S, et al. Sheathless guide catheter in transradial percutaneous coronary intervention for ST-segment elevation myocardial infarction. Catheter Cardiovasc Intv. 2015;Epub ahead of print.

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