Clinical and Procedural Outcomes of 5-French versus 6-French Sheaths in Transradial Coronary Interventions

Abstract

The radial artery has been increasingly used for its favorable safety profile. However, no conclusive data are available on the optimal sheath size. In particular, it is seemingly difficult to weight both advantages and disadvantages of narrower versus larger sheaths size. Despite several studies were performed to compare the use of 6-Fr to the smaller 5-Fr sheaths, these were mostly small, single center-studies, yielding various results.We performed a comprehensive meta-analysis of all available studies comparing the use of 5-Fr versus 6-Fr sheaths in coronary procedures through the TRA.Studies comparing a 5-Fr versus a 6-Fr sheaths were searched for in PubMed, the Cochrane Library, and ISI Web of Knowledge databases.Studies were deemed eligible if they only included patients undergoing transradial cardiac catheterization with 5-Fr or 6-Fr system and reported at least one of these parameters: contrast dye volume, procedural success, procedural time, access complications, radial artery occlusion, and bleedings.Odds ratio (OR) and the mean difference (MD) were respectively used for dichotomous and continuous variables as summary measures. Both the random-effects model and the fixed effect models were used for computation of meta-analyses. Heterogeneity was assessed by means of the Cochrane Q test. Metaregression was calculated using the unrestricted maximal likelihood random effects model.The use of a 5-Fr system is associated with a significant lower contrast medium administration (MD = −22.20 [−36.43 to −7.96], P < 0.01) and significantly reduces bleedings (OR = 0.58 [0.38–0.90], P = 0.02), without compromising procedural success (OR = 0.95 [0.53–1.69], P = 0.86) or procedure length (OR = 0.55 [−2.58 to 3.69], P = 0.73), compared to the 6-Fr system. Despite no significant difference was observed between the groups (OR = 0.88 [0.50–1.56], P = 0.67), at metaregression RAO incidence in the 5-Fr group was increasingly lower as the percentage of women included into the study increased (P = 0.02).Some potentially interesting technical details, such as sheath length, hydrophilic coating, or periprocedural anticoagulation, were not homogeneously reported in individual studies.Results of the present meta-analysis confirm the excellent safety profile of transradial procedures both with 5-Fr and 6-Fr system. A 5-Fr system could be preferred in patients with a higher bleeding propensity or kidney injury.

Effectiveness of a handmade “New Carotid Catheter” in transradial carotid angiography: A comparison with conventional multipurpose catheters

“…However, with accumulating physician experience and advances in technology, transradial coronary angiography has become more preferred thanks to lower complication rates and increased physician and patient comfort. Even for primary PCI, the prevalently radial route has begun to be adopted …”

“…Even for primary PCI, the prevalently radial route has begun to be adopted. [1][2][3][4][5][6][7][8] Many publications have reported the safety of radial access in coronary angiography. In recent years, the duration of transradial angiography has decreased, and the radial approach has also become safely applicable for peripheral interventions.…”

Diagnostic Performance of the Instantaneous Wave-Free Ratio

“…22,23 In addition, I 2 values were calculated for estimation of variation among studies attributable to heterogeneity as already described. 24 A fixed effect or a random effects model was used as appropriate, with a 2-sided P<0.05 considered significant.…”

Effect of introducer length on the rate of radial artery occlusion during endovascular coronary procedures: а pilot randomised clinical trial

“…В недавно опубликованном метаанализе, включавшем три рандомизированных и восемь нерандомизированных исследований, сравненивалась частота развития ОЛА при использовании интродьюсеров диаметром 5 и 6 F. Статистически значимой разницы в частоте ОЛА между двумя группами (отношение шансов 0,88 (0,50-1,56), р = 0,67) не обнаружено. Однако в метарегрессионном анализе наблюдалось увеличение преимуществ использования интродьюсера 5 Fr по мере возрастания процента женщин, включенных в исследование (р = 0,02) [18]. Следует отметить, что влияние длины интродьюсера на частоту ОЛА при транстрадиальных вмешательствах ранее не изучалось.…”