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Success of percutaneous coronary interventions (PCI) through Transradial access (TRA) relies on capable guiding catheters (GC). The GC's performance is partly driven by its distal shape. Most of the actual shapes address the problem of the back up support through optimized contact with the aortic ascending wall.
Through a shape modification in the shaft of existing GC, we tried to add a pendular effect, in order to make easier and safer the re-cannulation of coronary artery (CA) ostium. We tested the modification for GC used for left and right CA via right TRA, as for right CA via left TRA. The present communication reports the results of a modified GC aimed at RCA-PCI via right TRA.
The new shape was added to the actual 6F Heartrail™ II GC from Terumo and the catheter was tested on 46 consecutive patients requiring RCA PCI through 6F TRA. The catheter's performance was scored on a scale of 5 for ease of RCA cannulation (“friendly”), degree of support and level of safety (well aligned in the centre of the lumen's artery, no induced wall damage). Presence of a pendular effect, fluoroscopy time, volume of contrast used and, crossover to another GC were recorded. Level of difficulty of the PCI was evaluated as “easy” or difficult using a scoring system based on patient, aorta, coronary anatomy and lesions characteristics.
PCI was successful for 45 patients (one patient left with partial revascularization). 6 GC crossovers happened (to 3 RRAD and 3 AL1 curves). Ease of RCA cannulation was graded ≥ 3/5 for only 29 cases. For the 40 successful PCI with the new GC shape, degree of support and safety were respectively scored at 4,62 and 4,75/5. A pendulum-like effect was present for half of the cases. For the 22 PCIs classified as difficult, the crossover occurred for 3, support and safety remain at 4,2 and 4,5/5. The pendulum effect was detected for 14 (63%) of the 22 difficult cases but only for 8 of the 24 easy PCI (33%). There was no complication.
A pendulum-like effect was visible in 63 % of the difficult PCI. The GC shape modification provided a good support, allowing successful PCI for 40 of the 46 cases, and for 19 of the 22 difficult RCA cases. Further modifications are required for enhancing the ease of RCA cannulation.
- 2013 American College of Cardiology Foundation