PCI & AimRadial 2018 | FFR using 4Fr catheters: Can Slender Technique Work Here? - Ian C Gilchrist

1. FFR using 4Fr catheters: Can
Slender Technique Work Here?
Ian C Gilchrist, MD, FACC, FSCAI
Professor of Medicine
Penn State’s Hershey Medical Center
Heart & Vascular Institute
Hershey, PA
USA

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4 French Feasibility
Yadav, Gilchrist. JACC 2014;64(11_S)
Pop Test
Pulse-Duplicator
Area 4-F catheter = 3.14 mm2
Area 0.014” wire = 0.10 mm2
Mean difference = 0.006 [-0.052-0.064]
Legalery, et al. Am J Cardiol 2003;91:1075–1078
4F Diagnostic vs 7F Guide FFR
∆(4FFFR-7FrFFR)
µFFR

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4F vs 6F Diagnostic Catheter FFR
61 patients
4F FFR
FFR 0.70-0.90
Cut point 0.80
6F FFR
Paired Comparison
Moriyama N, et al. COFFEE Trial. JACC I 2018;;11:412-14

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Example: Taking it a Down a Notch
50 year old woman with recurrent atypical pain
RCA stent last year via left radial out of town
Stress test was equivocal
Small, light framed woman
Definitely wants a wrist approach again
Right radial
5F sheath
Option for intervention
icg 2017

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0.035” wire stopped at sheath
Right forearm angiogram via sheath
High origin of radial from brachial artery
High-branching radial
& spasm

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Switched to 4F
LCA- 4F JL3.5 RCA- 4F JR4.0

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Not Sure of RCA at Stent
stent
Options?
1. Go down under (groin)?
2. Contalateral radial?
3. Ulnars?
icg 2017

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FFR- 4 French Multipurpose
icg 2017

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General Coronary Set-Up
Hydrostatic transducer (Ao)
Electronic transducer (Co)
Computer
FFR, iFR, etc
Flushed Catheter
Clean Signal
No Catheter Damping
Wire
Normalized
Calibrated
Positioned

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Effects of Catheters in Different
Coronary Ostia
Toth, J Am Coll Cardiol. 2016;68(7):742-753.
5-F
6-F
7-F
4-F Catheter
Area 4-F catheter = 3.14 mm2
Area 0.014” wire = 0.10 mm2
4F
0.014” wire

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Lumen
Longitudinal Effects
THROMBIN CONTRAST
WHAT HAPPENS TO THE
PULSE WAVEFORM?
Ideal pressure wave
Ideal pressure wave
central obstacle
Lumen1
Lumen2

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4F Catheter Characteristics
Diagnostic only in US
Can’t directly do PCI if needed
Interface between wire & catheter
wall may add friction
Thermo-stability poor

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4-F Technique
Less forgiving than larger French
Use fresh catheter & rapidly introduce wire
Meticulous FFR/iFR technique needed
• Confirm lumen is well flushed
• Transducer or catheter is not-damped
• Dicrotic notches on tracing?
Lack of immediate interventional
capacity may temper patient choice

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Improvements Needed
Better understanding of wire/internal catheter
interface to improve coeffiecent of friction
4-F guides or equivalent (FFR catheters?)
Potential for smaller catheters if sensor also
placed on distal catheter
Goal: Use of the smallest diameter access into the radial artery required
for diagnosis will maximize long-term radial artery function

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Thank you
icg1@psu.edu
@RADIAL_icg