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Feasibility of transradial coronary angiography and intervention using a single Ikari left guiding catheter for ST
Jeremy Chow1, Chong Hiok Tan, Aung Soe Tin
1Department of Cardiology, Changi General Hospital, Singapore. jhchow@dr.com
Insights
Transradial coronary intervention (TRI) using a single Ikari left (IL) catheter is feasible for ST-elevation myocardial infarction (STEMI) patients. This approach shows comparable outcomes to traditional transfemoral intervention (TFI).
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Transradial coronary intervention (TRI) is common for ST-elevation myocardial infarction (STEMI).
- Limited data exists on using a single catheter for both diagnosis and intervention in TRI for STEMI.
- The Ikari left (IL) guiding catheter is a potential tool for single-catheter TRI.
Purpose of the Study:
- To evaluate the feasibility and outcomes of transradial coronary intervention (TRI) using a single Ikari left (IL) guiding catheter in STEMI patients.
- To compare TRI with a single IL catheter versus conventional transfemoral intervention (TFI) in STEMI.
Main Methods:
- Retrospective study of 362 STEMI patients (August 2007 - December 2008).
- Assessed feasibility of single IL catheter TRI.
- Compared TRI with IL versus TFI on door-to-perfusion time, procedural duration, fluoroscopy duration, and major adverse cardiac events (MACE).
Main Results:
- TRI was attempted in 185 patients with a 96.9% success rate using a single IL catheter.
- TRI with IL showed a trend towards shorter door-to-perfusion and procedural times compared to TFI.
- Major adverse cardiac events (MACE) were similar between TRI with IL and TFI groups.
Conclusions:
- Transradial coronary intervention (TRI) with a single Ikari left (IL) catheter is feasible and effective in STEMI patients.
- Outcomes of single IL catheter TRI are comparable to conventional transfemoral intervention (TFI) in experienced centers.
Background:
Transradial coronary intervention (TRI) has been widely adopted in ST elevation myocardial infarction (STEMI) patients but there is limited literature on the use of a single catheter for both diagnostic angiography and intervention. We aim to evaluate the feasibility and outcomes of TRI with a single Ikari left (IL) guiding catheter in STEMI patients.
Methods:
This is a retrospective study of 362 consecutive STEMI patients from August 2007 to December 2008. We assessed the feasibility of TRI with a single IL and compared this strategy with conventional transfemoral intervention (TFI) on the following outcomes: (1) door to perfusion time, (2) total procedural duration, (3) total fluoroscopy duration, and (4) major adverse cardiac events (MACE) by intention to treat analysis.
Results:
TRI was attempted in 185 patients. There were no failed radial cannulations. Overall success rate of primary TRI with a single IL was 96.9% and there were only 2 failures that required conversion to TFI. Compared to TFI, TRI with IL tended to a shorter median door to perfusion time, 90 (IQR 76.0 - 119.5) versus 98 (IQR 80.8 - 120.5) minutes (P = 0.07) and a shorter median procedure duration of 34 (IQR 27.0 - 45.0) versus 37 (IQR 28.0 - 49.3) minutes (P = 0.06). The median fluoroscopy duration was longer in the TRI group. MACE were comparable between the 2 groups.
Conclusion:
In experienced centers, TRI with a single IL catheter for STEMI is a feasible and effective approach and outcomes are comparable to conventional TFI.
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