Application of percutaneous transluminal coronary angioplasty guidewire in introducing artery sheath and catheter during transradial intervention / 第二军医大学学报

ABSTRACT

Objective To apply percutaneous transluminal coronary angioplasty (PTCA) guidewire (0. 014 inch, 1 inch= 2. 54 cm) for introducing a sheath, and to assess its safety and efficacy in completing the transradial percutaneous coronary intervention (PCI). Methods Twenty-one patients were included in this study. They were scheduled to undergo elective coronary intervention via the radial artery from January 2012 to March 2013, with normal Allen's test results, but the straight guidewire (0. 025 inch) failed to be inserted through the needle after successful puncture of radial artery via Seldinger technique. Then a PTCA guidewire was used to gently access the radial artery instead of the straight guidewire to the brachial artery; the needle was removed and a 6F sheath was introduced into the radial artery over the PTCA guidewire, and the 5F coronary angiography catheter was advanced to the brachial artery, replacing the PTCA guidewire with a guidewire (0. 035 inch). Then the angiography was completed, and the artery sheath was removed immediately after PCI. The access site-related complications including hematomas, perforation, pseudoaneurysm, and vasovagal reaction were observed immediately after operation and for 3 days. Results The 6F sheath were advanced into the radial artery over the PTCA guidewire in all the 21 cases and coronary angiography were successfully completed. And coronary intervention was performed in twelve (57. 1%) patients, with one patient having radial artery spasm. No extravasation of contrast media was noted immediately after operation; no vascular complications (access site bleeding, hematomas, pseudoaneurysm, and vasovagal reaction) were noted 3 days after operation; and the patients had a normal blood pressure after operation. Conclusion When the radial artery is successfully punctured and a straight guidewire (0. 025 inch) failed to be inserted, PTCA guidewire can be used instead to deliver the sheath to complete PCI. The method is safe, effective, and can increase the success rate of puncture of the radial artery and therefore may be an alternative for radial artery puncture.