title: Mini-invasive strategy in acute coronary syndromes: direct coronary stenting using 5 Fr guiding catheters and transradial approach.
abstract: The purpose of this study was to assess the feasibility and safety of direct coronary stenting in acute coronary syndromes using 5 Fr guiding catheters by transradial approach. A series of 119 patients with an acute coronary syndrome (unstable angina, n = 55; acute myocardial infarction, n = 45; recent acute myocardial infarction, n = 19) explored by transradial approach and eligible for direct stenting were included. A large proportion of patients (52%) was treated during the procedure by platelet IIb/IIIa receptor blockade. Only Medtronic 5 Fr guiding catheters were used in this study. Direct coronary stenting was attempted in all 119 highly selected patients. Failure of direct stenting was observed in only five cases (3.9%) and the stent successfully retrieved in each case in the 5 Fr guiding catheter. In these five cases, balloon predilation was performed and then the stent implanted successfully. Different stents were used: ACS stent (54%), AVE stent (33%), Velocity stent (10%), Nir stent (3%), with diameter ranging from 2.5 to 4 mm. In four cases, the dilation was finally performed using 6 Fr guiding catheters because the backup of the 5 Fr catheter was considered to be too low (3%). No vascular access site complications occurred in this series of patients. We conclude that direct coronary stenting using transradial approach and 5 Fr guiding catheters yields excellent procedural success rate. In the setting of acute coronary syndromes requiring platelet IIb/IIIa receptor blockade or after failure of thrombolysis, this mini-invasive strategy is very attractive because of the low risk of access site complications.
authors.affiliation: Service des Maladies du Coeur et des Vaisseaux, Centre Hospitalier Universitaire de Caen, Caen, France. hamon-m@chu-caen.fr
authors.forename: Martial
authors.initials: M
authors.lastname: Hamon
authors.forename: Rémi
authors.initials: R
authors.lastname: Sabatier
authors.forename: Quanming
authors.initials: Q
authors.lastname: Zhao
authors.forename: Rodica
authors.initials: R
authors.lastname: Niculescu
authors.forename: Benoît
authors.initials: B
authors.lastname: Valette
authors.forename: Gilles
authors.initials: G
authors.lastname: Grollier
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009203:Myocardial Infarction / Q000628:therapy*; D017534:Radial Artery; D015607:Stents; D016896:Treatment Outcome