Trans-Radial Coronary Interventions Using A Sheathless Guiding Catheter

Launched by UNIVERSITY HOSPITAL, GENEVA · Mar 31, 2011

Keywords

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Gender

ALL

Eligibility criteria

• Inclusion criteria:
• • Patients need to be at least 18 years old.
• • Patients presenting with a significant coronary artery disease who qualify for PCI and who can be treated by a radial approach.
• • Any women requiring PCI who can be treated by a radial approach.
• • Any patients with a bifurcation lesion or the ostial lesion of the left anterior descending (LAD) and/or left circumflex artery (LCX), lesions commonly treated with a 7 Fr guiding catheter.
• • Bifurcation lesion = any lesion of a main epicardial vessel (i.e. LAD, LCX, right coronary artery) involving at least one major side branch (i.e. diagonal or marginal branches).
• • Ostial lesion of the LAD or LCX = presence of a significant stenosis \<5mm from the distal part of the left main.
• Exclusion Criteria:
• • Patients who refused to give their written informed consent.
• • Male patients, in whom PCI can be easily performed with a 6 Fr standard guiding catheter (i.e. no bifurcation or ostial lesion).
• * Patients in whom the radial approach is contra-indicated:
• • Patients with a dialysis arteria-venous fistula or in whom an arteria-venous fistula is planed in the future.
• • Patients with a known radial artery occlusion.
• * Patients in whom a radial approach was unsuccessfully already attempted in the past (anamnestic notion or previous medical record) secondary to a:
• • Challenging vessel anatomy,
• • Vessel tortuosity,
• • Known impossibility to cannulate the coronary ostia by the radial approach.
• * Patients in whom the Allen test results pathological bilaterally:
• • In case of pathological Allen test in one hand the other hand will be tested before choosing the femoral approach.
• * Patients in whom the femoral approach is adopted as primary catheterization approach (at interventionist's discretion), including:
• • Unstable patients (myocardial infarction, cardiogenic shock).
• • Patients necessitating femoral access for an intra-aortic balloon counterpulsation
• • Patients presenting with a double mammary coronary graft (right and left internal mammary utilized for by-pass grafts).
• • Coronary interventions where an extreme good guiding support is mandatory (i.e. PCI of chronic total occlusion, PCI with Rotablator).
• • Particularly risky PCI (e.g., PCI of the left main artery), where the femoral approach may be more comfortable for the operator.
• • Patients requiring a femoral approach for a right heart catheterization.