Feasibility of transradial coronary angiography and intervention using a single Ikari left guiding catheter for ST elevation myocardial infarction.
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.


CONCLUSIONS
In experienced centers, TRI with a single IL catheter for STEMI is a feasible and effective approach and outcomes are comparable to conventional TFI.
Department of Cardiology, Changi General Hospital, Singapore. jhchow@dr.com
Jeremy
J
Chow
Chong Hiok
CH
Tan
Aung Soe
AS
Tin
Sea Hing
SH
Ong
Vern Hsen
VH
Tan
Yew Seong
YS
Goh
Hwa Wooi
HW
Gan
Kok Soon
KS
Tan
Jayaram
J
Lingamanaicker
D057785:Catheters; D017023:Coronary Angiography / Q000295:instrumentation* / Q000379:methods; D003331:Coronary Vessels / Q000473:pathology*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation* / Q000379:methods; D017534:Radial Artery; D012189:Retrospective Studies; D016896:Treatment Outcome