ABSTRACT
OBJECTIVE: To determine the impact of ostial guiding catheter disengagement during measurement of fractional flow reserve (FFR) in patients with an isolated proximal left anterior descending artery (LAD) stenosis. METHODS: Measurements of FFR were performed in 21 patients with an isolated intermediate lesion of the proximal LAD. Proximal aortic pressure (Pa), distal post stenotic pressure (Pd), and Pd/Pa were recorded at baseline, after at least 90 sec of intravenous (IV) adenosine infusion with the guiding catheter still engaged in the coronary ostium (Pa1 , Pd1 , FFReng ), and after at least 30 sec of guiding catheter disengagement back to the aorta (Pa2 , Pd2 , FFRdis ). RESULTS: The average value of Pd/Pa at baseline was 0.92 ± 0.04. After 110 ± 8 sec of IV adenosine infusion, FFReng was 0.81 ± 0.07, which decreased to 0.77 ± 0.08 (FFRdis ) after 38 ± 6 sec of guiding catheter disengagement. The mean ΔFFR (FFReng - FFRdis ) was 0.05 ± 0.04. As compared to baseline values, the mean change in FFR values was significantly increased after disengagement of the guiding catheter (Pd/Pabaseline - FFRdis vs. Pd/Pabaseline - FFReng , 0.15 ± 0.05 vs. 0.10 ± 0.04, P < 0.0001). Before guiding catheter disengagement, eight patients (38%) had an FFR value ≤ 0.8. Following disengagement of the guiding catheter, the new FFR values decreased below 0.8 in six additional patients (28%), with subsequent change in treatment strategy. CONCLUSIONS: During FFR assessment of isolated intermediate proximal LAD lesions, guiding catheter disengagement is associated with a decrease in mean FFR values. In patients with FFR values lying close to the treatment threshold, this can have an impact on treatment strategy.
Subject(s)
Cardiac Catheterization/instrumentation , Cardiac Catheters , Coronary Artery Disease/diagnosis , Coronary Stenosis/diagnosis , Fractional Flow Reserve, Myocardial , Aged , Blood Flow Velocity , Blood Pressure , Cardiac Catheterization/adverse effects , Coronary Artery Disease/physiopathology , Coronary Stenosis/physiopathology , Equipment Design , Equipment Failure , Female , Humans , Male , Middle Aged , Predictive Value of Tests , Time FactorsABSTRACT
OBJECTIVE: The aim of this study is to evaluate the feasibility and safety of the Glidesheath Slender in routine transradial (TR) coronary angiography and intervention. BACKGROUND: In recent years, The TR approach has gained in popularity because of several advantages such as reduced vascular access site complications and immediate patient mobilization. Procedural success has been further improved through technological innovations and the development of less invasive devices. The Glidesheath Slender (Terumo, Tokyo, Japan) is a new dedicated radial sheath with a thinner wall and hydrophilic coating. It combines an inner diameter compatible with 6Fr guiding catheter with an outer diameter close to current 5Fr sheaths. Its use has the potential to decrease invasiveness and access site complications during TR procedures. METHODS: A total of 114 consecutive patients undergoing TR coronary angiography and/or PCI using the Gidesheath Slender were included in a prospective single-center feasibility and safety study. RESULTS: Procedural success was 99.1% with only one case requiring conversion to femoral access. There were six minor hematomas but none of the patients experienced major vascular complications. The rate of symptomatic radial spasm was 4.4%. No case of major sheath kinking was noted. Doppler ultrasound examination of the radial artery at 1 month follow-up was available in 113/114 patients with only one case of radial artery occlusion (RAO) (0.88%). CONCLUSIONS: Routine use of the Glidesheath Slender for TR coronary angiography and interventions is safe and feasible with a high rate of procedural success and a low rate of RAO. © 2013 Wiley Periodicals, Inc.
