Concept and practice of 5 French transradial percutaneous treatment of coronary bifurcation lesions with conventional devices - Gregory Sgueglia

1. Concept and practice of 5 French
transradial percutaneous treatment of
coronary bifurcation lesions with
conventional devices
Gregory A. Sgueglia, MD, PhD
Sant’Eugenio Hospital
Rome, Italy

2. Stuttgart 21-22 September 2017
Concept and practice of 5 French transradial bifucartion PCI with conventional devices Gregory A. Sgueglia
Disclosures
• I have no financial conflicts of interest related
to this presentation

3. Stuttgart 21-22 September 2017
Concept and practice of 5 French transradial bifucartion PCI with conventional devices 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 bifurcations revascularization procedures
SguegliaGA.JACCIntv2012;5:803

4. Stuttgart 21-22 September 2017
Concept and practice of 5 French transradial bifucartion PCI with conventional devices Gregory A. Sgueglia
The clinical problem
6 Fr introducer
sheath diameter
SaitoS.CathetCardiovascIntervent1999;46:173

5. Stuttgart 21-22 September 2017
Concept and practice of 5 French transradial bifucartion PCI with conventional devices Gregory A. Sgueglia
Development and availability
of many new miniaturised
materials in Japan
0.010 inch guidewires
very low profile balloons
long dilators
4 Fr guiding catheters
Effective and safe
complex slender TRI
The solution in Japan

6. Stuttgart 21-22 September 2017
Concept and practice of 5 French transradial bifucartion PCI with conventional devices Gregory A. Sgueglia
The clinical need
• Reliance on a radial artery allowing to use a
sufficiently large guiding catheter may exclude
transradial access in a sizeable proportion of
patients
• Yet, transradial access has shown a reduction
in mortality and therefore urges operators to
identify new strategies that allow implementing
TRI in a growing number of patients

7. Stuttgart 21-22 September 2017
Concept and practice of 5 French transradial bifucartion PCI with conventional devices Gregory A. Sgueglia
Evolution of bifurcation PCI
The simple one-stent strategy is supported by
numerous trials that systematically failed to show
better results with a two-stent approach

8. Stuttgart 21-22 September 2017
Concept and practice of 5 French transradial bifucartion PCI with conventional devices Gregory A. Sgueglia
Evolution of bifurcation PCI
Foin N. JACC Intv 2012;5:47
Proximal optimization technique (POT) associated
with single balloon SB inflation is a valid kissing
balloon alternative to allow SB dilation without
compromising the MV stent geometry

9. Stuttgart 21-22 September 2017
Concept and practice of 5 French transradial bifucartion PCI with conventional devices Gregory A. Sgueglia
Methods
• Full 5 French procedure
• Only conventional devices:
• workhorse 0.014 inch coronary guidewires,
• regular semi-compliant or non-compliant balloons
• market leader drug-eluting stents
Phase A
(20 patients)
Bifurcations
of increasing
complexity
Phase B
(60 unselected patients)
Assessment of 5F bifurcation PCI
as a systematic procedure

10. Stuttgart 21-22 September 2017
Concept and practice of 5 French transradial bifucartion PCI with conventional devices Gregory A. Sgueglia
Methods

11. Stuttgart 21-22 September 2017
Concept and practice of 5 French transradial bifucartion PCI with conventional devices Gregory A. Sgueglia
Results

12. Stuttgart 21-22 September 2017
Concept and practice of 5 French transradial bifucartion PCI with conventional devices Gregory A. Sgueglia
Results

13. Stuttgart 21-22 September 2017
Concept and practice of 5 French transradial bifucartion PCI with conventional devices Gregory A. Sgueglia
Results
• Angiographic success with 5F in 78 patients
• Catheter upgrade for SB stenting in 2 patients:
• one had flow limiting dissection  culotte
• one had residual stenosis >70%  TAP
• Type 4a MI in one patient who had multivessel
PCI

14. Stuttgart 21-22 September 2017
Concept and practice of 5 French transradial bifucartion PCI with conventional devices Gregory A. Sgueglia
Results
0
30
60
90
PhaseA Phase B
0
15
30
45
PhaseA Phase B
Minutes
Minutes
Total procedural duration Fluoroscopy time
p=0.09
p=0.032

15. Stuttgart 21-22 September 2017
Concept and practice of 5 French transradial bifucartion PCI with conventional devices Gregory A. Sgueglia
Conclusions
• This concept series demonstrate the feasibility
of 5 French bifurcation intervention with non-
dedicated devices and preliminary supports its
efficacy and safety over a wide range of
bifurcation anatomy and complexity
• Careful methodology is of paramount
importance to increase success and avoid
complications

16. Stuttgart 21-22 September 2017
Concept and practice of 5 French transradial bifucartion PCI with conventional devices Gregory A. Sgueglia
Acknowledgements
• Sant’Eugenio Hospital, Rome, Italy
Prof. Achille Gaspardone, Dr. Fabrizio D’Errico,
Dr. Fabiana Piccioni, Dr. Antonella De Santis
Dr. Gaetano Gioffrè,Dr. Francesco Summaria
• S.M. Goretti Hospital, Latina, Italy
Dr. Edoardo Pucci, Dr. Daniel Todaro,
Dr. Micaela Conte, Dr. Antonino Stipo