The document discusses the use of a 6.5F sheathless guiding catheter for transradial percutaneous coronary interventions (PCI) in patients with small radial arteries. The sheathless guiding catheter has an external diameter smaller than a 5F sheath but an internal diameter larger than a standard 6F guiding catheter. Several studies found that using the 6.5F sheathless guiding catheter for transradial PCI was feasible, effective, and safe for treating all lesion types and with various interventional techniques. The sheathless guiding catheter was particularly useful in cases where there was friction during intervention with smaller 4F-5F diagnostic catheters and sheaths or when a vessel was very small after use of a 6

1. Use of 6.5F sheathless guiding catheter in
patients with small radial artery
Y. Louvard, ICPS, Massy, générale de
Santé, France

2. Disclosure Statement of Financial Interest
Within the past 12 months, I or my spouse/partner have had a financial
interest/arrangement or affiliation with the organization(s) listed below.
Affiliation/Financial Relationship Company
• Grant/Research Support
• Consulting Fees/Honoraria
• Major Stock Shareholder/Equity
• Royalty Income
• Ownership/Founder
• Intellectual Property Rights
• Other Financial Benefit
• Company Names
• Terumo, Medtronic
• Company Names
• Company Names
• Company Names
• Company Names
• Company Names

3. Sheathless Transradial Intervention Using Standard Guide Catheters
A 5-Fr diagnostic catheter inserted into and through a 7-Fr guiding catheter and over a 0.035
inch standard J-tip wire for easier percutaneous insertion of the guiding catheter into the radial
artery
From, CCI 76:911–916 (2010)

4. Feasibility of transradial coronary intervention using a sheathless
guiding catheter in patients with small radial artery
The sheathless GC system (sheathless Eaucath, Asahi Intecc®, Japan). A: 6.5 Fr. hydrophilic GC
illustrated with central dilator. B and C: Central dilator was inserted into GC and locked. D: GC with
central dilator can be advanced along the 0.035” wire. GC: guiding catheter.
YJ Youn, Korean Circ J 2011;41:143-148

5. Complex transradial PCI using a sheathless guide catheter
Comparison of the outer and inner diameters of the Sheathless Eaucath and the conventional
introducer sheath and guide catheter system. Introducer sheath measurements are for the
Radifocus Introducer II (Terumo, Tokyo, Japan). Guide catheter dimensions are for the
Medtronic Launcher (Medtronic, Minneapolis, MN, USA).
Harding, Heart, Lung and Circulation 2013;22:188–192

7. 6Fsheathless coronary angioplasty using a novel technique to introduce
the guiding catheter: the INTRUC, a preliminary retrospective study
Meyer, Catheterization and Cardiovascular Diagnosis 43:331–335 (1998)

8. Use of the Sheathless Guide Catheter During Routine
Transradial Percutaneous Coronary Intervention: A Feasibility Study
Mamas, CCI 75:596–602 (2010)

9. Feasibility and safety of transradial P CIusing a 6.5-F sheathless guiding catheter in
patients with small radial arteries: a multicenter registry (148 pts, 252 lesions)
Cheaito, Louvard, CCI, online

10. Feasibility and safety of transradial P CIusing a 6.5-F sheathless guiding catheter in
patients with small radial arteries: a multicenter registry (148 pts, 252 lesions)
Cheaito, Louvard, CCI, online

11. Feasibility and safety of transradial P CIusing a 6.5-F sheathless guiding catheter in
patients with small radial arteries: a multicenter registry (148 pts, 252 lesions)

12. Use of the Sheathless Guide Catheter During Routine
Transradial Percutaneous Coronary Intervention: A Feasibility Study
Baseline Clinical Demographics/Characteristics
Mamas, CCI 75:596–602 (2010)

13. Use of the Sheathless Guide Catheter During Routine
Transradial Percutaneous Coronary Intervention: A Feasibility Study
Mamas, CCI 75:596–602 (2010)
Procedural Characteristics

14. Use of the Sheathless Guide Catheter During Routine
Transradial Percutaneous Coronary Intervention: A Feasibility Study
Mamas, CCI 75:596–602 (2010)
Lesion Characteristics

15. Use of the Sheathless Guide Catheter During Routine
Transradial Percutaneous Coronary Intervention: A Feasibility Study
Radial occlusion (doppler ultrasound) at 2 two: 2 patients
Related to particular complications at the time of the procedure:
- catheter knotted in the subclavian artery during removal
and could not be unknotted and so was withdrawn with traction
through the radial artery.
- radio-ulnar loop was traversed with the guide catheter.
Mamas, CCI 75:596–602 (2010)
.

16. Comparison of novel 6.5 Fr sheathless guiding catheters versus 5 Fr
guiding catheters for transradial coronary intervention
Baseline clinical characteristics.
Chiam, EuroIntervention 2011;7:930-935

17. Comparison of novel 6.5 Fr sheathless guiding catheters versus 5 Fr
guiding catheters for transradial coronary intervention
Baseline lesion characteristics.
Chiam, EuroIntervention 2011;7:930-935

18. Comparison of novel 6.5 Fr sheathless guiding catheters versus 5 Fr
guiding catheters for transradial coronary intervention
Procedure results
Chiam, EuroIntervention 2011;7:930-935

19. Complex transradial PCI using a sheathless guide catheter
Patient Demographic and Clinical Data.
Harding, Heart, Lung and Circulation 2013;22:188–192

20. Complex transradial PCI using a sheathless guide catheter
Lesion Characteristics.
Harding, Heart, Lung and Circulation 2013;22:188–192

21. Complex transradial PCI using a sheathless guide catheter
Procedural Characteristics.
Harding, Heart, Lung and Circulation 2013;22:188–192

22. Complex transradial PCI using a sheathless guide catheter
Angiographic success 97.5%
3 failures : 1 CTO, 1 no flow post PPCI
occlusion (1), no flow following primary
PCI
suboptimal balloon angioplasty
non-STEMI 4.2%
Inhospital TVR or death 0%
procedural success 93.3%.
Haematomas > 5 cms = 2 patients
(Abciximab)
Radial occlusion: 2.5%
Harding, Heart, Lung and Circulation 2013;22:188–192

23. High-speed rotational atherectomy using the radial artery approach and a sheathless
guide (7.5F): comparison with the “conventional” femoral approach (8F)
Demographic characteristics (n=135 patients)
Kassimis, EuroIntervention 2014; January 2014

24. High-speed rotational atherectomy using the radial artery approach and a sheathless
guide (7.5F): comparison with the “conventional” femoral approach (8F)
Angiographic and procedural characteristics.
Kassimis, EuroIntervention 2014; January 2014

25. High-speed rotational atherectomy using the radial artery approach and a sheathless
guide (7.5F): comparison with the “conventional” femoral approach (8F)
In-hospital outcomes.
Kassimis, EuroIntervention 2014; January 2014

26. How does it work ?
Dg 5F Sheathless
6F
7 cms
Unstable
6F
Sheathless
6.5F
Brachio-radial
Patel
technique
Keep the sheath ?

32. • 48 yo
• Male
• Smoking, family history
• Ressuscitated sudden death
• Sinus rythm
• 105 / 58 mmHg
• Some Adrenaline
• Right TRA 5F
• At night …

33. Right radial angio 5F

34. Right radial angio 4F (friction)

35. Right arm pullback angio

36. Looking for an elbow level connection

37. 1 wire only

38. Predilatation

39. Stenting
Xience 3.5X8

40. Post stenting

41. Post dilatation
Balloon 4.5

42. Final result

43. Conclusions
• 6.5 sheathless guiding catheter Eaucath (Asahi)
- external diameter smaller than 5F sheath
- internal diameter larger than standard 6F GC
- highly hydrophilic on its whole length (slippery!)
- thermal stability lower than some other GC (Medtronic …)
• Safe, effective, adapted to all lesions and techniques
• To be used
- in case of friction on diagnostic catheters 4/5F with 4/5F
sheath
- after a 6F sheath in case of very small vessel (angio, no leak)
- inside a 6F sheath in case in big sinuous radial, brachial and
Subclavian arteries