title: 5-Fr sheathless transradial cardiac catheterization using conventional catheters and balloon assisted tracking; a new approach to downsizing.
abstract: BACKGROUND
  While the uptake of transradial access site is growing, there are concerns about associated radial injury. We report a feasibility study of a technique that enables both 5Fr diagnostic and PCI cases to be undertaken without an arterial sheath using conventional diagnostic and guide catheters with a modified balloon assisted tracking (BAT) technique.
  
  
  METHODS
  We performed a prospective single center pilot study to assess the feasibility and effectiveness of sheathless radial artery access and BAT to perform coronary angiography and angioplasty using conventional 5 Fr diagnostic and guide catheters. We assessed for successful acquisition of good quality angiogram, completion of the angioplasty and access site complications.
  
  
  RESULTS
  5 Fr sheathless cardiac catheterization was undertaken in diagnostic (55%) and PCI cases (45%, all indications) in 60 consecutive patients (mean age 62.8±11.4years) using conventional catheters. The procedure was successfully performed via the radial artery using a sheathless technique with BAT in 93.3% of patients. All patients had a patent radial artery following removal of the Helix device and there were no recorded access site complications.
  
  
  CONCLUSIONS
  Trans-radial cardiac catheterisation for diagnostic and PCI cases using 5F Sheathless catheters (whose outer diameter is smaller than a 3Fr introducer sheath) with BAT appears feasible and allows both cardiac catheterization for diagnostic and PCI indications to be undertaken safely using conventional catheters through the radial route, with high success rates.
authors.affiliation: Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK; Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands Trust, Stoke-on-Trent, UK. Electronic address: mamasmamas1@yahoo.co.uk.
authors.forename: Mamas A
authors.initials: MA
authors.lastname: Mamas
authors.affiliation: Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK.
authors.forename: Sudhakar
authors.initials: S
authors.lastname: George
authors.affiliation: Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK.
authors.forename: Karim
authors.initials: K
authors.lastname: Ratib
authors.affiliation: Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK; Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands Trust, Stoke-on-Trent, UK.
authors.forename: Chun Shing
authors.initials: CS
authors.lastname: Kwok
authors.affiliation: Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands Trust, Stoke-on-Trent, UK.
authors.forename: Abdelnasir
authors.initials: A
authors.lastname: Elkhazin
authors.affiliation: Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands Trust, Stoke-on-Trent, UK.
authors.forename: Kully
authors.initials: K
authors.lastname: Sandhu
authors.affiliation: Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands Trust, Stoke-on-Trent, UK.
authors.forename: Julie
authors.initials: J
authors.lastname: Stubbs
authors.affiliation: Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands Trust, Stoke-on-Trent, UK.
authors.forename: Pamela
authors.initials: P
authors.lastname: Luxford
authors.affiliation: Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK; Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands Trust, Stoke-on-Trent, UK.
authors.forename: James
authors.initials: J
authors.lastname: Nolan
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D062906:Cardiac Catheters; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D017023:Coronary Angiography / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000628:therapy*; D004739:England; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011677:Punctures; D017534:Radial Artery / Q000000981:diagnostic imaging; D016896:Treatment Outcome
keywords: Balloon assisted tracking; Percutaneous coronary intervention; Sheathless; Transradial catheterization