Cardiologists at the Mayo Clinic have come up with a new prodecure to prevent lesions during angioplasty.
By eliminating the use of a sheath in transradial percutaneous coronary intervention (PCI) on the wrist, the cardiologists were able to prevent radial complications (bleeding or infection from the incision site in the radial artery) in 90 percent of patients.
PCI, commonly known as angioplasty, is a procedure used to open narrowed or blocked coronary arteries. According to the National Heart Lung and Blood Institute, angioplasty is performed on more than one million Americans each year.
During the procedure, cardiac interventionists make a small incision, threading a catheter into the femoral artery in the groin or through the radial artery in the wrist, to access the blockage in the heart. The latter approach, called transradial angioplasty, is increasing in use due to quick patient recovery and lower complications at the access site. However, a major limitation of transradial PCI is the inability to use large guiding catheters because of the small size of the radial artery.
To explore this issue, Charanjit Rihal, MD, FSCAI, and colleagues from the Mayo Clinic performed transradial PCI using a sheathless technique with standard guiding catheters. In the traditional method of PCI that uses the femoral artery for access, a "catheter sheath" is placed in the artery opening. This sheath keeps the artery open as well as helps control bleeding. Unfortunately the sheath also adds more equipment into the already narrow radial artery space, something that is not an issue in the wide femoral artery, but is an issue when going through the wrist.
The team chose to use the new sheathless procedure on ten patients who had transradial angioplasty for stable angina (60%) and acute coronary syndrome (40%) between September 2009 and March 2010. The new procedure was attempted on 15 vessels and bifurcation (complex) lesions were present in six patients.
While current medical evidence report use of guiding catheters with hydrophilic coating and long central dilators during sheathless transradial PCI; these devices are currently not available in the U.S. In the current study, all procedures were performed using 7 Fr ("French", a measurement of the diameter or medical tubing and catheters)(six patients) or 8 Fr (four patients) Vista Brite Tip® guiding catheters which are non-hydrophilic coated.
"We showed the safety and feasibility of performing complex PCI through large-bore guiding catheters from the radial artery using a sheathless technique. This affords patients all the benefits of radial access for even the most complex coronary procedures," said Dr. Rihal. The series results showed PCI was successful in all but one patient who had a completely obstructed obtuse marginal artery that could not be crossed. One minor coronary complication was reported—a small
vessel dissection within the lesion of interest which was covered with a stent. This patient was asymptomatic and dismissed in good health after one night of observation.
During the follow-up period there were no deaths and no radial artery spasms once the guide was taken out. "Sheathless transradial PCI using standard large-bore guiding catheters is a safe and effective method for treatment of complex lesions," concluded Dr. Rihal.
Details of this novel approach are published in the December issue of Catheterization and Cardiovascular Intervention, the official journal of The Society for Cardiovascular Angiography and Interventions.