Transradial coronary intervention using a novel 5‐Fr sheathless guiding catheter

We have recently developed a 5‐Fr sheathless guiding catheter system (Virtual 3‐Fr, Medikit, Japan), composed of a hydrophilic catheter and a central dilator. This combination of catheter and dilator enables us to introduce the catheter into the artery without the need of an introducer sheath. Because the outer diameter of this 5‐Fr sheathless guiding catheter system is approximately 2‐Fr sizes smaller than a conventional guiding catheter system, this system provides us with less invasive angioplasty and a puncture site injury equivalent to a conventional 3‐Fr introducer sheath. To demonstrate the potential of this 5‐Fr sheathless guiding system, we report two cases of chronic total occlusion successfully treated by the transradial approach. This novel 5‐Fr sheathless system may become a viable alternative to conventional guiding catheters, and provide a favorable impact upon vascular access complications and patient morbidity. © 2009 Wiley‐Liss, Inc.     

Renal artery intervention using a virtual 4.5‐Fr guiding catheter

A 6.5‐Fr guiding catheter (Parent Plus 45, Medikit, Tokyo, Japan), composed of a hydrophilic sheathless guiding catheter and a dilator, has recently been developed for the treatment of renal artery stenosis. Because of its unique sheathless configuration, its outer diameter is comparable to that of a conventional 4.5‐Fr introducer sheath, with the inner diameter being close in size to a 6.5‐Fr guiding catheter. These features allow this sheathless system to be used as the sole guiding catheter while the arterial damage at the puncture site remains equivalent to that of a 4.5‐Fr introducer sheath. We thus call this novel sheathless guiding catheter a virtual 4.5‐Fr system. To demonstrate the potential of this virtual 4.5‐Fr system, we report a case of renal artery stenosis successfully treated via the transradial route. This virtual 4.5‐Fr system may become a viable alternative to conventional guiding catheters, and provide a favorable impact upon vascular access complications and patient morbidity. © 2012 Wiley Periodicals, Inc.     

Percutaneous coronary intervention with a virtual 2‐Fr system

With the improvement of percutaneous coronary intervention (PCI), the miniaturization of devices has continued. We have developed a virtual 2‐Fr system that is the slenderest system to date. The outer diameter of the system using a 4‐Fr sheathless guiding catheter is ～2‐Fr size. We report a case successfully treated using this new system. This novel virtual 2‐Fr system has the potential to provide less invasive PCI during vascular access and to reduce patient morbidity. © 2010 Wiley‐Liss, Inc.     

Coronary intervention with 4‐French catheters

Objectives: We sought to determine whether 4‐Fr percutaneous coronary intervention (PCI) is associated with technical difficulties that might have an unfavorable impact on procedural parameters. Background: Four‐Fr PCI is often associated with difficulties in catheter manipulation, which may lead to greater time consumption and increased dye usage when compared with PCI employing larger guiding catheters. Methods: From July 2007 to March 2009, 62 patients underwent 4‐Fr PCI. Procedural characteristics were compared between patients who underwent 4‐Fr PCI in 2007 (early phase: 31 lesions in 26 patients) and those underwent in 2008 or later (later phase: 40 lesions in 36 patients). Results: Ad‐hoc coronary intervention (3% vs. 23%, P < 0.05) and deep‐vessel intubation (46% vs. 91%, P < 0.05) were observed less frequently in the late phase than the early phase. Fluoroscopy time (8 ± 6 min vs. 17 ± 15 min, P < 0.05) and the amount of contrast dye used (64 ± 33 mL vs. 90 ± 46 mL, P < 0.05) were significantly reduced in the late phase than the early phase. No access site‐related complications were observed in patients in either phase. Conclusions: The performance of 4‐Fr PCI requires a certain learning curve, following which a reduction in fluoroscopy time and use of contrast dye may be achieved. This improvement in procedural parameters and the low incidence of access site‐related complications might allow 4‐Fr PCI to serve as a minimally invasive approach for the treatment of coronary artery diseases. © 2009 Wiley‐Liss, Inc.     

Backup support of the mother-child technique: technical considerations for the size of the mother guiding catheter

Background : We previously proposed a technique called the “mother–child technique” to facilitate stent delivery for complex coronary lesions. This technique is applicable when the backup support of the guiding catheter is insufficient. In this study, we used an in vitro coronary artery tree model to determine the impact of the size of the mother guiding catheter on the backup support of the mother–child guiding system. Methods : The backup support was measured for the 4‐in‐5, 4‐in‐6, 4‐in‐7, and 4‐in‐8 systems as well as for the 5‐in‐6, 5‐in‐7, and 5‐in‐8 systems. Results : Advancement of the child catheter into the coronary artery tree model improved the backup support of the mother–child system. When a 4‐Fr child catheter was advanced by 9 cm, the relative increase in the backup support was 174% in the 4‐in‐5 system; it was 203% in the 4‐in‐6, and 135% in the 4‐in‐7 system (P < 0.05 vs. the mother catheter alone). The relative increase with the 5‐Fr child catheter was 289% in the 5‐in‐6 system, and 152% in the 5‐in‐7 system (P < 0.0001 vs. the mother catheter alone). However, the improvement in the backup support with 9‐cm child catheter advancement did not reach statistical significance for either the 4‐in‐8 (115%) or the 5‐in‐8 (112%) system (P = NS). Conclusions : The relative increase in the backup support of the mother–child system was inversely related to the size of the mother guiding catheter. Thus, the mother–child technique may be most useful for PCIs in which a small guiding catheter is used, such as transradial coronary interventions. © 2012 Wiley Periodicals, Inc.     

Amplatzing a 6 Fr Judkins right guiding catheter for increased success in complex right coronary artery anatomy.

Stent supported angioplasty is being performed in an increasing number of patients and, with advances in device technology, more morphologically complex lesions are being treated. In such a setting, it is extremely important to deliver the device to the target lesion. We describe a new technique that allows successful stent delivery in complex right coronary anatomy using the Judkins right guiding catheter. Cathet Cardiovasc Intervent 2001;53:405-409.     

Double loop guiding catheter: A primary catheter for angioplasty of the right coronary artery

Double loop guiding catheters have been used for percutaneous transluminal coronary angioplasty (PTCA) of the right coronary artery (RCA) in 42 consecutive cases. A catheter with a 90- degree primary curve was used when the proximal RCA had horizontal or inferior orientation. When the proximal segment of the RCA was oriented superiorly (shepherd's crook), the catheter with a 75-degree primary curve was used. Catheters were fabricated with short (1.5 cm) or long (2.3 cm) (USCI, C.R. Bard, Inc., Billerica, MA) distal tips. Short-tip catheters were satisfactory in the majority of cases. When the RCA had a complex course and more backup was necessary or when the ascending aorta was wide, long-tip catheters were found to be the best choice. Angioplasty of 49 lesions was attempted in 42 consecutive patients. In 39 patients successful dilatation was achieved (93%). In three patients the procedure was unsuccessful. In one patient, the lesion could not be crossed with the guidewire despite an excellent backup. In another patient, two of three stenoses were dilated successfully; the distal lesion was crossed with a guidewire but could not be crossed with the balloon catheter in spite of a good backup. The lack of a satisfactory engagement and inadequate backup were responsible for the failure in only one patient. There were no complications related to these guiding catheters. We conclude that double loop guiding catheters are safe and can be the primary choice in all right coronary angioplasties. These catheters provide an excellent backup with consequent high success rate.     

Percutaneous coronary intervention and 30‐day mortality: The British Columbia PCI risk score

Objectives : To construct a calculator to assess the risk of 30‐day mortality following PCI. Background : Predictors of 30‐day mortality are commonly used to aid management decisions for cardiac surgical patients. There is a need for an equivalent risk‐score for 30‐day mortality for percutaneous coronary intervention (PCI) as many patients are suitable for both procedures. Methods : The British Columbia Cardiac Registry (BCCR) is a population‐based registry that collects information on all PCI procedures performed in British Columbia (BC). We used data from the BCCR to identify risk factors for mortality in PCI patients and construct a calculator that predicts 30‐day mortality. Results : Patients (total n = 32,899) were divided into a training set (n = 26,350, PCI between 2000 and 2004) and validation set (n = 6,549, PCI in 2005). Univariate predictors of mortality were identified. Multivariable logistic regression analysis was performed on the training set to develop a statistical model for prediction of 30‐day mortality. This model was tested in the validation set. Variables that were objective and available before PCI were included in the final risk score calculator. The 30‐day mortality for the overall population was 1.5% (n = 500). Area under the ROC curve was 90.2% for the training set and 91.1% for the validation set indicating that the model also performed well in this group. Conclusions : We describe a large, contemporary cohort of patients undergoing PCI with complete follow‐up for 30‐day mortality. A robust, validated model of 30‐day mortality after PCI was used to construct a risk calculator, the BC‐PCI risk score, which can be accessed at www.bcpci.org . © 2009 Wiley‐Liss, Inc.     

Probe “balloon on a wire” ultra-low-profile coronary catheter: Results of ptca in 107 patients

A new low-profile “balloon-on-a-wire” angioplasty catheter, the Probe? (USCI), was used in 107 patients over a 4-month period. Twenty-nine patients had stable angina, 59 had unstable angina, and 19 had had myocardial infarction (Ml) 3 to 15 days prior to the procedure; 71 patients had single-vessel and 36 had multi-vessel disease. In this series, 57 lesions were defined as complex. Successful dilatation was defined as a residual stenosis of <30%. Of 132 non-total obstructions, 127 (97%) were successfully dilated. Two distal lesions could not be reached, two lesions could not be crossed by the balloon, and a distal lesion dilatation resulted in acute closure in one case. Of 19 total obstructions, 16 (84%) were successfully dilated (mean residual stenosis 23%). The wire tip was unable to cross the lesion in the three unsuccessful procedures. Seven complications occurred in the series, all involving non-total obstructions: closure of a distal vessel and a side branch caused no clinical symptoms or EKG changes; three local dissections were tacked back with repeat dilatation; and two longitudinal dissections caused no apparent reduction in luminal diameter. The Probe's low-profile and exceptional trackability enabled it to cross very tight lesions with minimal trauma to the vessel wall. The high degree of conformability of the PET balloon minimizes vessel straightening or sheer forces and appears to reduce the potential for dissection. The device may therefore extend the indications and ease of PTCA while reducing complications of the procedure.     

Long-tip guiding catheter: Successful and safe for left coronary artery angioplasty

A long-tip guiding catheter was designed for angioplasty of the left coronary artery. Principal factors of guiding catheter function were identified, and the catheter's shape was designed to utilize them efficiently. Emphasis was placed on an overbent secondary curve (150–180°) for more precise catheter control. The distal tip of the catheter is 2 cm long in the 4.0 size and the primary bend is shallow, ～20%. A 1.5 cm long segment between the secondary and tertiary curves enhances stability and support. Catheter performance was studied during procedures on 90 patients; 89 patients underwent coronary artery angioplasty and one patient underwent diagnostic angiography. The success rate for angioplasty was 95% with no major complications. Mild pressure damping occurred in 18 patients, and mild catheter displacement from the left main coronary artery occurred in 24 patients. Catheter support was judged as excellent to very good in 82 patients. Judkins or Amplatz catheters were not required during this study. The observed disadvantages of the long-tip catheter were the risk of catheter buckling up during advancement into the left main coronary artery and, perhaps, a higher risk of pressure damping. Superselective engagement of the catheter in the left anterior descending or circumflex arteries may be a problem when the left main coronary artery is very short. This study showed the long-tip catheter to be safe and highly successful for angioplasty of the left coronary artery.     

Percutaneous closure of a coronary aneurysm with a vein-coated stent

Coronary artery aneurysm is a rare but recognized complication following percutaneous intervention. We report the formation of such an aneurysm after recanalization with Excimer laser wire of a chronic totally occluded left anterior descending coronary artery and stent implantation and its subsequent treatment using an autologous vein graft-coated stent. Cathet. Cardiovasc. Diagn. 43:308–310, 1998. © 1998 Wiley-Liss, Inc.     

Excimer laser facilitated percutaneous coronary intervention of a nondilatable coronary stent.

A patient is described in which excimer laser percutaneous coronary intervention is performed inside a suboptimally expanded stent due to nondilatable calcified plaque. The use of excimer laser facilitated full expansion of the stent with a balloon.     

SAL指引导管使用56例初步经验

目的:初步总结短头AL（short amplatz left,SAL）指引导管（guiding catheter,GC）的使用经验,评价SAL GC的使用特点及安全性。方法: 回顾分析总结我科56例使用SAL导管行右冠状动脉（RCA）介入治疗患者的影像特点,操作过程及最终结果。56例患者中慢性完全性闭塞（CTO）病变29例;病变迂曲8例;病变明显钙化10例;迂曲并发钙化5例;病变位于RCA远端且近中段迂曲14例。结果: 56例患者中SAL GC成功到位53例（95%）,3例不能到位。53例使用SAL GC完成PCI手术,PCI成功46例,成功率87%,失败7例（13%）,均为CTO病变;CTO病变的成功率为76%（22/29）,失败原因为导丝不能通过5例,术中过敏反应1例,心室颤动1例,均顺利中止手术。56例中无1例发生RCA开口或近端夹层,也无右窦内夹层发生。结论: SAL GC操作简单,容易到位,适合大部分RCA复杂病变,具有良好的安全性。     

Percutaneous coronary intervention for stable coronary artery disease

Patients with significant coronary artery stenoses are at increased risk of future cardiac events. However, in the absence of acute coronary syndrome or recent myocardial infarction and residual ischemia, elective percutaneous coronary intervention has not been shown to improve prognosis. Possible explanations for this might be the limited follow-up time adopted by most randomized trials comparing percutaneous coronary intervention with medical therapy, limited number of patients with proven ischemia enrolled in these trials, and adoption of complex, elaborate techniques that have not proved their usefulness. Published evidence identifies certain indications for percutaneous coronary intervention in patients with stable coronary lesions: demonstration of significant inducible ischemia, particularly in the context of a recent myocardial infarction; detection of unequivocally reduced fractional flow reserve; and specific angiographic features of coronary stenoses. Operators should take into account long-term consequences of adopted techniques rather than immediate angiographic results. We review existing evidence and provide our recommendations in this setting.     

Emergency trans‐catheter coronary intervention for left main compression secondary to pulmonary hypertension in a 4‐year‐old child

Here, we report on the case of a 4‐year‐old child with large atrial septal defect (ASD) and severe pulmonary hypertension presenting an ischemic cardiomyopathy secondary to left main (LM) compression by a dilated pulmonary artery trunk. Despite of surgical treatment consisting in ASD closure and coronary artery bypass grafting, the patient was not weanable from ECMO. Control coronarography showed a near‐occlusion of the left mammary bypass. A rescue percutaneous LM angioplasty with drug‐eluting stent implantation was performed.     

Percutaneous coronary intervention with stent implantation in haemophilic A patient with unstable angina

The prevalence of coronary artery disease (CAD) and acute coronary syndromes in patients with haemophilia is much lower than in general population and there is a lack of information regarding safe interventional or surgical treatment of CAD in haemophiliacs. This report presents a case of patient with moderate haemophilia A and unstable angina pectoris, who underwent successful coronary angioplasty. The patient was pretreated with factor VIII (before and after the procedure) and the incision site was sealed with vessel closure device. Additionally, the article discusses the issue of the safety of standard, postpercutaneous coronary intervention antiplatelet therapy in patients with haemophilia.     

Novel use of a high‐energy excimer laser catheter for calcified and complex coronary artery lesions

This study was designed to evaluate safety and effectiveness of the 0.9 mm excimer laser coronary catheter with increased laser parameters. We report a prospective trial of 100 calcified and/or balloon‐resistant lesions where a new 0.9 mm excimer laser catheter was used at standard or higher energy level to facilitate angioplasty. Standard in‐hospital clinical and angiographic parameters were collected and measured. Laser technical success was obtained in 87 lesions (92%), procedural success was reached in 88 lesions (93%), and clinical success in 82 lesions (86%). Increased laser parameters were used for 29 resistant lesions. This new 0.9 mm excimer laser coronary catheter using higher energy parameters seems to be safe and effective for management of calcified and nondilatable lesions. Catheter Cardiovasc Interv 2004;62:155–161. © 2004 Wiley‐Liss, Inc.     

A first‐in‐man study of the reitan catheter pump for circulatory support in patients undergoing high‐risk percutaneous coronary intervention

Objectives : To investigate the safety of a novel percutaneous circulatory support device during high‐risk percutaneous coronary intervention (PCI). Background : The Reitan catheter pump (RCP) consists of a catheter‐mounted pump‐head with a foldable propeller and surrounding cage. Positioned in the descending aorta the pump creates a pressure gradient, reducing afterload and enhancing organ perfusion. Methods : Ten consecutive patients requiring circulatory support underwent PCI; mean age 71 ± 9; LVEF 34% ± 11%; jeopardy score 8 ± 2.3. The RCP was inserted via the femoral artery. Hemostasis was achieved using Perclose? sutures. PCI was performed via the radial artery. Outcomes included in‐hospital death, MI, stroke, and vascular injury. Hemoglobin (Hb), free plasma Hb (fHb), platelets, and creatinine (cre) were measured pre PCI and post RCP removal. Results : The pump was inserted and operated successfully in 9/10 cases (median 79 min). Propeller rotation at 10,444 ± 1,424 rpm maintained an aortic gradient of 9.8 ± 2 mm Hg. Although fHb increased, there was no significant hemolysis (4.7 ± 2.4 mg/dl pre vs. 11.9 ± 10.5 post, P = 0.04, reference 20 mg/dl). Platelets were unchanged (pre 257 ± 74 × 10⁹ vs. 245 ± 63, P = NS). Renal function improved (cre pre 110 ± 27 μmol/l vs. 99 ± 28, P = 0.004). The RCP was not used in one patient following femoral introducer sheath related aortic dissection. All PCI procedures were successful with no deaths or strokes, one MI, and no vascular complications following pump removal. Conclusions : The RCP can be used safely in high‐risk PCI patients. This device may be an alternative to other percutaneous systems when substantial cardiac support is needed. © 2009 Wiley‐Liss, Inc.