Transradial Szabo technique for intervention of ostial lesions.

OBJECTIVES: The aim of our study is to assess the feasibility and safety of transradial intervention (TRI) of coronary ostial lesions using the Szabo technique. BACKGROUND: When performing TRI of coronary ostial lesions, precise stent positioning is of paramount importance. TRI has experienced increasing popularity in the U.S.; however, utilization of the Szabo technique has not been systematically evaluated in this setting. We report the results of ostial stent deployment using the Szabo technique for 2 experienced TRI operators and centers. METHODS: This was a retrospective analysis of 40 consecutive patients who underwent PCI from April 2009 to September 2011. All patients who underwent PCI via the transradial route with the Szabo technique for ostial lesions performed by experienced transradial operators (>200 cases/yr) were included. RESULTS: In our study of 40 patients with 41 coronary ostial lesions, overall procedural success rate was 100%. Stent dislodgement was seen in 1 patient. Clinical follow up was 100%, with a mean duration of 292.7±200 days. Target lesion revascularization (TLR) was seen in 2 patients (5%). One patient had an episode of transient ischemic attack (TIA) at 33 days after PCI; another experienced subacute stent thrombosis at 81 days while on dual antiplatelet therapy. MACE was 7.5% overall. CONCLUSION: In our study, treatment of coronary ostial lesions with the Szabo technique via TRI is associated with a high procedural success rate and a low MACE of 7.5%.

Feasibility and safety of 7F sheathless guiding catheter during transradial coronary intervention.

OBJECTIVE: The aim of our study is to assess the feasibility, safety, and rate of radial artery occlusion (RAO) using 7F sheathless guiding catheter in a large population undergoing transradial intervention (TRI). BACKGROUND: There is a frequent need for large bore guiding catheter to perform complex coronary interventions. Hydrophilic sheathless guiding catheters are not available in the US, therefore, we present the results of a multicenter study using the modified sheathless technique and readily available catheters. METHODS: Between December 2010 and February 2011, 116 consecutive patients from four tertiary US centers who underwent TRI using 7F sheathless guiding catheter were included in this study. RESULTS: In our study of 116 patients with 123 coronary lesions, 57 stenoses (49%) were complex interventions, which included patients with acute coronary syndromes, chronic total occlusion (CTO), bifurcation stenting, calcified lesions, left main artery, and saphenous venous graft interventions. Overall procedural success rate was 95%. At 7-day, there were six patients (5%) with RAO, of which two of the six had severe radial artery spasm during the procedure. At 30-day, the overall persistent RAO was only detected in three patients (2.5%), as three patients had return of antegrade radial artery flow. CONCLUSIONS: In our multicenter study of 116 consecutive patients, using 7F sheathless guiding catheter to perform TRI is associated with a high procedural success (95%) and a low 30-day RAO rate (2.5%).

Transradial measurement of transvalvular pressure gradient in the setting of mechanical aortic and mitral valve prostheses using a coronary fractional flow reserve guidewire.

Accurate measurement of transvalvular pressure gradients is essential to comprehensively evaluate whether mechanical prosthetic valves are functioning normally. Direct measurements can be technically complicated, traditionally requiring direct, transapical puncture in the setting of both aortic and mitral mechanical valve prostheses. Very few case reports have proposed the use of guidewires indicated for coronary fractional flow reserve assessment to evaluate the transvalvular pressure gradients and hemodynamic status of patients with both aortic and mitral valve mechanical prostheses. We present one such case of a 59-year-old male with history of rheumatic heart disease and double mechanical valve replacements of the aortic and mitral valves presenting with contradictory clinical signs and noninvasive testing evidence of decompensated congestive heart failure and possible dysfunction of a mechanical, bi-leaflet aortic valve prosthesis. The use of a low-profile, intracoronary guidewire with a pressure transducer near the distal tip indicated for coronary fractional flow reserve determination proved very useful to answer this important question. Additionally, we report the first case of the use of this technology for this purpose via the radial artery access approach.