Feasibility and safety of a virtual 3‐Fr sheathless‐guiding system for percutaneous coronary intervention

BackgroundRadial artery occlusion (RAO) may occur posttransradial intervention and limits the radial artery as a future access site, thus precluding its use as an arterial conduit. In this study, we investigate the incidence and factors influencing the RAO in the current literature.Methods and ResultsWe searched MEDLINE and EMBASE for studies of RAO in transradial access. Relevant studies were identified and data were extracted. Data were synthesized by meta‐analysis, quantitative pooling, graphical representation, or by narrative synthesis. A total of 66 studies with 31 345 participants were included in the analysis. Incident RAO ranged between <1% and 33% and varied with timing of assessment of radial artery patency (incidence of RAO within 24 hours was 7.7%, which decreased to 5.5% at >1 week follow‐up). The most efficacious measure in reducing RAO was higher dose of heparin, because lower doses of heparin were associated with increased RAO (risk ratio 0.36, 95% CI 0.17–0.76), whereas shorter compression times also reduced RAO (risk ratio 0.28, 95% CI 0.05–1.50). Several factors were found to be associated with RAO including age, sex, sheath size, and diameter of radial artery, but these factors were not consistent across all studies.Conclusions RAO is a common complication of transradial access. Maintenance of radial patency should be an integral part of all procedures undertaken through the radial approach. High‐dose heparin along with shorter compression times and patent hemostasis is recommended in reducing RAO.

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“…A total of 66 studies met the inclusion criteria . The process of study selection is shown in Figure .…”

Section: Resultsmentioning

confidence: 99%

Radial Artery Occlusion After Transradial Interventions: A Systematic Review and Meta‐Analysis

Rashid

Kwok

Pancholy

et al. 2016

JAHA

296

267

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“…The 5 Fr sheathless guiding catheter (Medikit Co., Ltd) is advanced using a specialised insertion system. Use for treatment of complex coronary artery disease has been described in detail 23 . Successful treatment of CTO lesions has been shown to be possible with this system 24 , and a recent case report showed that a 4 Fr guiding catheter (KIWAMI, Heartrail; Terumo Corp.) can be inserted into the 5 Fr guiding catheter to improve stent delivery 25 .…”

Section: Sheathless Techniques Sheathless Systemsmentioning

confidence: 99%

“…Recently, Tonomura et al reported on 132 consecutive patients who underwent PCI using this system 23 . The procedural success rate was 95%.…”

Section: Sheathless Techniques Sheathless Systemsmentioning

confidence: 99%

Focus on maximal miniaturisation of transradial coronary access materials and techniques by the Slender Club Japan and Europe: an overview and classification

Kiemeneij¹,

Yoshimachi²,

Matsukage³

et al. 2015

EuroIntervention

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“…Mizuno et al reported success in 24/27 cases with crossover to conventional 6F in three cases, and more recently Kurotobi et al reported procedural success in 126/132 selected cases of simple PCI with cross-over to conventional PCI in six cases [31,32]. These studies therefore show that the diminutive 5F sheathless system from MediKit is successful for simple PCI with a very small outer diameter equivalent to a 3F sheath.…”

Section: Medikit Work Sheathless Guide Systemmentioning

confidence: 76%

Transradial Sheathless Approach for PCI

Fraser

Mamas

2015

Curr Cardiol Rep

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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.

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Feasibility and safety of a virtual 3‐Fr sheathless‐guiding system for percutaneous coronary intervention

Abstract: PCI using the virtual 3-Fr system is a feasible and viable alternative to conventional procedures that use a sheath and GC in appropriately selected patients. This small-caliber system may minimize endovascular trauma, particularly during transradial coronary procedures.

Cited by 11 publications

References 23 publications

Radial Artery Occlusion After Transradial Interventions: A Systematic Review and Meta‐Analysis

Radial Artery Occlusion After Transradial Interventions: A Systematic Review and Meta‐Analysis

Focus on maximal miniaturisation of transradial coronary access materials and techniques by the Slender Club Japan and Europe: an overview and classification

Transradial Sheathless Approach for PCI

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