Slender versus conventional approach reduces post-procedural upper extremity dysfunction after transradial coronary procedures.

AIMS: We compared the incidence of post-procedural radial artery occlusion (RAO) and upper extremity dysfunction (UED), in patients undergoing conventional versus slender transradial (TRA) coronary procedures. METHODS AND RESULTS: UED was assessed by the QuickDASH, before conventional (i.e., ≥6F) and slender (i.e., "virtual" 3F to 5F) procedures, after 2 weeks and 2 months. RAO was assessed by Duplex in patients with an abnormal reversed Barbeau test (RBT). A total of 212 patients were included, UED after 2 weeks was 12%, and after 2 months 7% (p = <.001). RAO occurred in 3%. Multivariate analysis showed an OR of 0.26 (CI0.08-0.84) for UED at 2 weeks (p = .03) in favor of slender TRA. In patients with RAO, UED did not improve at 2 months (2/5, 40%, p = .046). CONCLUSIONS: The occurrence of UED after TRA procedures is temporary except for patients with RAO. Slender TRA seems able to reduce short term UED.

"Virtual" 3 Fr Transradial Coronary Stenting With the 5 Fr Meito Masamune Sheathless Guiding Catheter: Feasibility and Safety in an Outpatient Setting.

AIM: To assess the safety and feasibility of "virtual 3 Fr" transradial percutaneous coronary intervention (TRA-PCI) in an outpatient setting. METHODS AND RESULTS: A retrospective analysis of a single-operator log-book, for the first 2 months after its CE-mark approval, identified 11/52 patients (21%; 6/11 males; mean age, 64 ± 10 years) who had undergone: (1) an elective TRA-PCI; (2) in an outpatient setting; and (3) with the sheathless 5 Fr Meito-Masamune guiding catheter (Medikit Co, Ltd). Procedural success was 96% (25/26 lesions), mean procedural time and contrast usage were 26 ± 15 minutes and 94 ± 69 mL, respectively. Patent hemostasis was successful in 10/11 patients, all patients were discharged home within 6 hours, and no acute radial artery occlusion occurred. CONCLUSIONS: Virtual 3 Fr TRA-PCI in highly selected patients seems feasible and safe when performed in an outpatient setting.

Percutaneous treatment of bifurcated lesions: a simple approach with a single bare metal R stent provides favourable long term clinical results.

AIMS: Target lesion revascularization (TLR) rates of bifurcated lesions (BL) remain high, mainly due to side branch (SB) restenosis, even when drug-eluting stents (DES) are used. The aim of our study was to evaluate long-term clinical outcomes of a stepwise approach with single bare metal R stent implantation for BL. METHODS AND RESULTS: In 465 patients, PCI was performed using a double guide wire, single stent in main branch (MB), and angioplasty of the SB, aiming at an optimal angiographic result of the MB and an optimal functional result (TIMI 3 flow) of the SB. 105 patients were treated for a true bifurcated lesion (TBL) and 360 patients were treated for a lesion with involvement of a significant side branch (ISB). Procedural success was achieved in all TBL and in 99% of ISB. At 1 year clinical follow-up, 8.6% treated for TBL had clinically driven TLR, 7.6% underwent repeat PCI, 1.0% underwent CABG. For patients treated for ISB, 13% had clinically driven TLR, 9.4% underwent repeat PCI, 3.6% CABG. 4 patients treated for TBL suffered non-fatal MI vs. 20 patients treated for ISB. Cardiac death occurred in 1.9% and 2.5 % respectively. CONCLUSION: A simple approach in the percutaneous treatment of BL using a single bare metal R stent results in good 1 year clinical outcome comparable to the outcome reported following DES implantation.