Are 7 Fr Dedicated Transradial Introducers Safe?

Courtesy of Dr. Carlos Fava.

The transradial approach has been proven beneficial for quite some time now, but certain scenarios require the use of a 7 Fr or 8 Fr introducer, which is a great limitation.

This study included 60 patients who underwent complex angioplasty with the help of 7 Fr dedicated transradial (TR) introducer Glidesheath Slender (Terumo, Tokyo, Japan).

This new introducer combines an inner diameter compatible with any 7 Fr (2.46 mm) guiding catheter and an outer diameter smaller than current 7 Fr (2.79 mm) sheaths.

Left main coronary artery (LMCA) lesions, complex bifurcation lesions, chronic total occlusions (CTO), and cases of rotational atherectomy and severe vascular tortuosity were all defined as complex lesions.

The primary endpoint was procedural success, understood as completing the scheduled angioplasty, and the secondary endpoint was the occurrence of major bleeding, vascular access complications, spasms, and radial artery occlusion.

Mean patient age was 66 years old (most subjects were male). Right transradial access was used in 56 patients, and bilateral access was used in 4 patients. Additionally, 13 patients had already received prior transradial access.

Treated lesions were distributed as follows: unprotected LMCA (20 patients), complex bifurcation lesions (16 patients), chronic total occlusions (15 patients), and rotational atherectomy (10 patients).

The primary endpoint was reached in 97% of all cases. One patient with right coronary CTO could not be rechanneled and another patient presented severe subclavian tortuosity, requiring conversion to a transfemoral approach.

On the other hand, the secondary endpoint was present in 10 patients: 3 of them presented access-site complications (two type II local hematoma and one uncomplicated radial artery dissection), and another 7 presented spasms.

Doppler ultrasound imaging at 30 days was carried out in 62 of 64 patients with radial access, with three cases of radial artery occlusion (4.8%).

Conclusion

Use of the 7 Fr Glidesheath Slender dedicated introducer for complex coronary interventions proved to be feasible. As a matter of fact, this study showed a high rate of procedural success and a low rate of vascular complications. These favorable results need to be confirmed in larger multicenter studies.

Editorial Comment

As we all know, the transradial approach has proven to be highly beneficial. In this case, technological advances allow us to move towards increasingly complex scenarios, while maintaining procedural safety and efficacy, with low rates of radial artery occlusion (particularly for CTO, for which the transfemoral approach is preferred).

Courtesy of Dr. Carlos Fava.

Original Title: First Prospective multicenter Experience With the 7 French Glidesheat Slender for Complex Transradial Coronary Intervention.

Reference: Adel Aminian, et al Catherization Cardiovascular Intervention 2017;89:1014-1020.