Access-site complications of transradial percutaneous coronary intervention using sheathless guiding catheters for acute
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ORIGINAL ARTICLE
Access‑site complications of transradial percutaneous coronary intervention using sheathless guiding catheters for acute coronary syndrome: a prospective cohort study with radial ultrasound follow‑up Tsuyoshi Isawa1 · Kazunori Horie1 · Masataka Taguri2 · Tatsushi Ootomo1 Received: 30 July 2019 / Accepted: 2 December 2019 © Japanese Association of Cardiovascular Intervention and Therapeutics 2019
Abstract The advantages of sheathless guiding catheters over the conventional approach using sheaths in percutaneous coronary intervention (PCI) regarding access-site complications, particularly ultrasound-diagnosed radial artery occlusion (RAO), remain unknown. The present study investigated the incidence of access-site complications of transradial primary PCI using sheathless guiding catheters in acute coronary syndrome (ACS). This prospective study evaluated access-site complications in 500 patients with ACS undergoing sheathless transradial primary PCI. Doppler ultrasound evaluation of the radial arteries was performed 2 and 30 days after the procedure. Sheathless guiding catheters (7.5-Fr) were used in 91.0% of the patients. The procedural success rate was 98.4%. Ultrasound-diagnosed RAO rates were 2.0% and 3.8% at 2- and 30-day follow-ups, respectively. Logistic regression analysis identified that the sheath-to-artery ratio (per 0.1) (odds ratio [OR] 5.71; 95% confidence interval [CI] 1.18–27.71; p = 0.001) was associated with more frequent RAO and that hypertension (OR 0.22; 95% CI 0.06–0.81; p = 0.023) was associated with less frequent RAO. Receiver operating characteristic curve analysis revealed that a sheath-to-artery ratio of 1.47 was the cutoff for 30-day post-procedural RAO (sensitivity 72%, specificity 81%). Sheathless transradial primary PCI for ACS was associated with a low incidence of access-site complications and a higher sheath-to-artery ratio cutoff for RAO than that expected from conventional PCI using sheaths based on historical data, demonstrating the access-site safety of sheathless guiding catheters and their benefit in PCI for ACS (University Hospital Medical Information Network-Clinical Trial Registry Number UMIN000019931). Keywords Sheathless guiding catheter · Radial artery occlusion · Acute coronary syndrome · Sheath-to-artery ratio
Introduction Access-site complications such as radial artery occlusion (RAO) [1] are sometimes encountered after transradial percutaneous coronary intervention (PCI) using conventional
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12928-019-00632-7) contains supplementary material, which is available to authorized users. * Tsuyoshi Isawa [email protected] 1
Department of Cardiology, Sendai Kousei Hospital, 4‑15, Hirose‑machi, Sendai 980‑0873, Japan
Department of Data Science, Yokohama City University School of Data Science, Yokohama, Japan
2
sheaths. PCI using a guiding catheter system without a conventional sheath, i.e., a sheathless guiding catheter (SheathLess Eaucath®;
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