Related Experiment Videos
Percutaneous transluminal coronary angioplasty through six French catheters
Insights
Percutaneous coronary angioplasty (PTCA) using a 6 French guiding catheter is safe and effective in selected patients. This study shows a high success rate and low complication rate, improving with experience.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Diagnostic catheters are crucial for guiding interventions in coronary artery disease.
- The use of smaller French size guiding catheters may offer advantages in specific patient populations.
Purpose of the Study:
- To evaluate the safety and efficacy of using a 6 French diagnostic catheter as a guiding catheter in percutaneous coronary angioplasty (PTCA).
Main Methods:
- Retrospective analysis of 221 PTCA procedures utilizing a 6 French guiding catheter.
- Procedures were performed via femoral or axillary approach, with varying lesion complexities.
- Both fixed-wire and monorail systems were employed, with detailed recording of procedural parameters and outcomes.
Main Results:
- Successful dilation was achieved in 84% of cases using the 6 French catheter alone; overall success rate was 95% after upsizing in 14% of patients.
- Experience with 6 French catheters improved over time, with a higher success rate in the latter half of the study (92% vs. 77%).
- The major complication rate was 3.2%, including moderate CK elevation, emergent bypass surgery, and one in-hospital death.
Conclusions:
- PTCA can be safely and effectively performed using a 6 French guiding catheter in selected patients.
- The use of 6 French guiding catheters demonstrates a learning curve, with improved outcomes in later cases.
- Smaller French size guiding catheters are a viable option for PTCA, contributing to successful revascularization with acceptable morbidity.
Abstract:
We present the results of 221 coronary angioplasty (PTCA) procedures in which a 6 French diagnostic catheter was chosen as a guiding catheter. A total of 218 were done through a femoral and 3 through an axillary approach. Total occlusion PTCA was done in 9 (4%) and multivessel PTCA in 19 procedures (9%). In 191 (86%) procedures a fixed-wire system was used (ACE Scimed, Probe USCI, Orion Cordis), and in 30 (14%) a monorail system (Speedy Schneider, Express Scimed). The mean nominal inflated balloon diameter was 2.9+/-0.3 mm (range 2.0-4.0), and the catheter internal lumen varied between 0.041 and 0.055 inch. In 186 procedures (84%) all targeted lesions could be successfully dilated through the 6 French catheter. In 30 (14%) patients, the guiding catheter was changed to a 7 or 8 French, for an overall success rate of 95%. Results with 6 French catheters were significantly better in our late experience (success rate of 92% for the last 110 procedures compared to 77% for the first 111 procedures) (p less than 0.01). There were no new Q-wave myocardial infarctions, but 6 patients (2.7%) had moderate CK elevation, 1 required emergent bypass surgery, 1 underwent emergent coronary stenting, and there was 1 in-hospital death. The overall major complication rate was 3.2%. In selected patients, PTCA can be safely and effectively done through a diagnostic 6 French guiding catheter.(ABSTRACT TRUNCATED AT 250 WORDS)