Transradial and slender percutaneous coronary intervention: less invasive strategy in PCI
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CURRENT OPINION ARTICLE
Transradial and slender percutaneous coronary intervention: less invasive strategy in PCI Yuji Ikari • Takashi Matsukage • Fuminobu Yoshimachi Motomaru Masutani • Shigeru Saito
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Received: 1 February 2010 / Published online: 3 July 2010 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2010
Abstract Although there is a discussion on the outcome between percutaneous coronary intervention (PCI) and bypass surgery, PCI is clearly superior to bypass surgery in terms of less invasiveness. One of the further less invasive strategy is transradial approach (TRI). There have been several limitations such as low backup force of guiding catheters. However, mechanics studies showed that the backup force does not relate to approach site but to catheter shape and size. The other strategy is slender PCI using a 5 Fr or less guiding catheter. The slender PCI has also several limitations, however, some of these limitations have been overcome using new slender devices and new slender specific techniques. In this article, current progress in this field using new devices is reviewed. The less invasive strategy such as TRI and slender PCI may be the future direction of PCI because they prevent complications and improve quality of life.
Y. Ikari (&) T. Matsukage Department of Cardiovascular Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan e-mail: [email protected] F. Yoshimachi Department of Cardiology, Aomori Prefectural Central Hospital, Aomori, Japan M. Masutani Department of Cardiology, Hyogo Medical College, Hyogo, Japan S. Saito Department of Cardiology, Shonan Kamakura Hospital, Kamakura, Japan
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Keywords Transradial intervention Slender PCI Backup force Coronary artery disease
Transradial coronary intervention Historical consideration of approach site of coronary catheterization The first cardiac catheterization was performed from the brachial vein to the right side of the heart by Dr Forssmann, an urologist, using his own body in 1929. He received the Nobel Prize for Medicine in 1956 because he opened the gate for cardiac catheterization. Dr Sones performed coronary diagnostic catheterization via the brachial artery on October 30, 1958. Thus, catheterization from the upper limb is rather an old idea. Following Dr Sones, Dr Judkins started transfemoral coronary diagnostic catheterization using the Judkins catheter he designed [1]. Dr Gruntzig reported the first coronary angioplasty case via transfemoral approach in 1978 [2]. As percutaneous coronary intervention (PCI) was invented during popular use of the Judkins catheter, transfemoral approach using the Judkins catheter became the standard in PCI. Furthermore, the Judkins catheter had a sophisticated design for easy engagement to the coronary artery. Since during the 1980s and 1990s PCI devices including atherectomy, stents or balloons were big, an 8 Fr or larger guiding catheter was necessary. Transfemoral intervention (TFI) using a large guiding catheter was
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