Use of 5 French Guiding Catheters in Transradial Coronary Intervention Procedures

Background: Transradial coronary intervention (TRI) is a widely practiced procedure in Taiwan. Most TRIs are performed using 6 French guiding catheters. Use of smaller-sized vascular sheaths and guiding catheters may further decrease the incidence of vascular access complication, but demand more operator experience and skills in manipulation of the catheter. We report our experience in using 5 French vascular sheaths and guiding catheters for TRI. Methods: One hundred and sixty consecutive patients who underwent transradial coronary intervention were retrospectively analyzed. Patient demographics, lesion characteristics and procedure-related outcomes were recorded. Results: Procedural success rates were 96.3% in the 5 French group (n = 81), 92.7% in the 6 French group (n = 41) and 92.1% in the 7 French group (n = 38), respectively. Four patients in the 5 French group needed to upsize to 6 or 7 French vascular sheaths and guiding catheters. Three of these four patients failed the TRI procedure; one patient obtained procedural success after crossover to transfemoral approach. There was a significant difference in the volume of contrast medium used (211.9 vs. 247.8 vs. 272.9 ml in the 5, 6 and 7 French groups, respectively; p < 0.001) and incidence of acute renal failure (0% vs. 9.8% vs. 5.4% in the 5, 6 and 7 French groups, respectively; p = 0.024). There was also a tendency of less post-procedural drop of hemoglobin level (0.5 vs. 0.9 vs. 0.9 g/dl in the 5, 6 and 7 French groups, respectively; p = 0.09) in the 5 French group. The procedural success rate of 5 French TRI showed continuous improvement over the study period. Ninty-five percent of patients in the last quarter of this study period were managed with 5 French sheath. In the late phase of this study, 100% procedural success was obtained in the 5 French group, and more complex lesions could be managed than in the early phase (type B2 or C lesion: 86.5% vs. 56.8% in the late and early phase). Conclusion: Use of 5 French vascular sheath and guiding catheter for TRI is safe and feasible, with procedural success rate comparable with those using 6 or 7 French guiding catheters, and with reduced amount of contrast medium injection and lower incidence of acute renal failure. After a learning curve, most patients can be managed with 5 Fr sheath and guiding catheter with a high success rate.