Ad hoc PCI in patients with poor radial access: the Little Women study - Gregory Sgueglia

1. Ad hoc PCI in patients with anticipated
poor radial access:
the Little Women study
Gregory A. Sgueglia, MD, PhD
Sant’Eugenio Hospital
Rome, Italy

2. Stuttgart 21-22 September 2017
Ad hoc PCI in patients with anticipated poor radial access: the Little Women study Gregory A. Sgueglia
Disclosures
• I have no conflict of interest related to this
presentation to declare

3. Stuttgart 21-22 September 2017
Ad hoc PCI in patients with anticipated poor radial access: the Little Women study Gregory A. Sgueglia
Advantages of radial access
Higher patient’s
comfort
Better outcomes
Early discharge
Reduced
bleedings

4. Stuttgart 21-22 September 2017
Ad hoc PCI in patients with anticipated poor radial access: the Little Women study Gregory A. Sgueglia
Background
When coronary anatomy is not known and
urgent treatment is required, most operators
consider that 6 French is the default size of TRI
guiding catheter because it allows implementing
most percutaneous revascularization procedures
Baseline 6 Fr transradial SKS
(2.5/48 & 2.5/38 mm)
Final result
SguegliaGA.IJC2016;203:1100

5. Stuttgart 21-22 September 2017
Ad hoc PCI in patients with anticipated poor radial access: the Little Women study Gregory A. Sgueglia
Background
When coronary anatomy is not known and
urgent treatment is required, most operators
consider that 6 French is the default size of TRI
guiding catheter because it allows implementing
most percutaneous revascularization procedures
6 French 6 French 6 French
Sheath introducer Diagnostic catheter(s) Guiding catheter(s)
The 6 French workflow

6. Stuttgart 21-22 September 2017
Ad hoc PCI in patients with anticipated poor radial access: the Little Women study Gregory A. Sgueglia
High probability of a
radial artery allowing
complex PCI
Low probability of a
radial artery allowing
complex PCI
Nurse
Letizia
Doctor
Sgueglia
The clinical problem

7. Stuttgart 21-22 September 2017
Ad hoc PCI in patients with anticipated poor radial access: the Little Women study Gregory A. Sgueglia
The clinical problem
What would you do if you expect the radial artery
is (very) small?
Would you use 5 French catheters?
What about if the patient has an indication to ad
hoc PCI (e.g. acute coronary syndrome)?
Would you go femoral?
If the patient has an acute coronary syndrome,
you know that going femoral increases mortality.
Would you try 5 French PCI?
What if you have to treat a true bifurcation?

8. Stuttgart 21-22 September 2017
Ad hoc PCI in patients with anticipated poor radial access: the Little Women study Gregory A. Sgueglia
“Real progress happens only when
advantages of a new technology
become available to everybody”
Henry Ford

9. Stuttgart 21-22 September 2017
Ad hoc PCI in patients with anticipated poor radial access: the Little Women study Gregory A. Sgueglia
The clinical problem
How to warrant a full transradial coronary
procedure in people with an anticipated poor
radial artery when ad hoc PCI is the
recommended strategy?
6 French 5 French 6 French
Sheath introducer Diagnostic catheters Guiding catheter(s)
The Little Women workflow

10. Stuttgart 21-22 September 2017
Ad hoc PCI in patients with anticipated poor radial access: the Little Women study Gregory A. Sgueglia
Aim of the study
To assess optimal strategy ensuring effective
and potentially complex ad hoc TRI in patients
with anticipated poor radial access

11. Stuttgart 21-22 September 2017
Ad hoc PCI in patients with anticipated poor radial access: the Little Women study Gregory A. Sgueglia
Study design
6 French 5 French 6 French
Sheath introducer JL 3.5 e JR 4
diagnostic catheters
Guiding catheter(s)
The Little Women workflow
6 French 6 French 6 French
Sheath introducer JL 3.5 e JR 4
diagnostic catheters
Guiding catheter(s)
The 6 French workflow
vs.
Short stature
women
(<160 cm)

12. Stuttgart 21-22 September 2017
Ad hoc PCI in patients with anticipated poor radial access: the Little Women study Gregory A. Sgueglia
Patients characteristics
Overal
(n=120)
5 Fr Group
(n=57)
6 Fr Group
(n=63)
p
Age (years) 68±11 67±14 68±8 0.69
Height (cm) 155±8 154±6 155±5 0.87
Weight (kg) 55±6 56±8 54±5 0.81
Body mass index 22±4 22±4 22±3 0.76
Active smoking 28 (23%) 12 (21%) 16 (25%) 0.57
High blood pressure 53 (44%) 26 (46%) 27 (43%) 0.76
High cholesterol 42 (35%) 18 (32%) 24 (38%) 0.45
Diabetes mellitus 34 (28%) 13 (23%) 21 (33%) 0.20
Family history of CVD 22 (18%) 12 (21%) 10 (16%) 0.46
Unstable presentation 70 (58%) 33 (58%) 37 (59%) 0.92

13. Stuttgart 21-22 September 2017
Ad hoc PCI in patients with anticipated poor radial access: the Little Women study Gregory A. Sgueglia
Results
0
10
20
30
40
50
5 Fr 6 Fr
Radial spasm
0
2
4
6
8
10
12
5 Fr 6 Fr
Switch to another access
Percentage
Percentage
p=0.03
p=0.04

14. Stuttgart 21-22 September 2017
Ad hoc PCI in patients with anticipated poor radial access: the Little Women study Gregory A. Sgueglia
0
2
4
6
5 Fr 6 Fr
Access-related pain
Results
VisualAnalogicScalescore
p=0.038
0
10
20
30
5 Fr 6 Fr
Time to lesion crossing
Minutes
p=0.013
Total time
to lesion crossing

15. Stuttgart 21-22 September 2017
Ad hoc PCI in patients with anticipated poor radial access: the Little Women study Gregory A. Sgueglia
Conclusions
• In patients with anticipated poor radial access,
the most straightforward and effective strategy
for ad hoc TRI is 6 French introducer sheath
placement, 5 French coronary angiography,
and 6 French coronary intervention
• In these patients, the risk of radial occlusion
needs to be gauged against the advantage of
performing a transradial procedure, including
reduced mortality, especially in clinical settings
more frequently requiring ad hoc PCI

16. Stuttgart 21-22 September 2017
Ad hoc PCI in patients with anticipated poor radial access: the Little Women study Gregory A. Sgueglia
Acknowledgements
• Sant’Eugenio Hospital, Rome, Italy
Prof. Achille Gaspardone, Dr. Gaetano Gioffrè,
Dr. Antonella De Santis, Dr. Fabrizio D’Errico
• S.M. Goretti Hospital, Latina, Italy
Dr. Edoardo Pucci, Dr. Daniel Todaro,
Dr. Micaela Conte, Dr. Antonino Stipo