This study compared the use of Sheathless Eaucath guiding catheters to standard guiding catheters for transradial percutaneous coronary interventions (TR PCI) in 233 patients. The Sheathless catheter reduced equipment size in the radial artery and was as safe and effective as standard catheters, with comparable complication rates. Crossing over to the Sheathless catheter after standard catheter failure allowed successful PCI in most cases. Patients reported less pain and operators found it easier to cross the arm with the Sheathless catheter.

1. Trans-radial percutaneous coronary interventions using a
Sheathless Eaucath guiding catheter compared to standard
guiding catheter: a randomized study
Tessitore E, Noble S, Gencer B, Rigamonti F, Bunwaree S,
Righini M, Robert-Ebadi H, Roffi M. Bonvini RF
AIM RADIAL - III
Chicago - October 2014

2. Disclosure
• Speaker honoraria for Cordis (radial workshop)
• Proctor for Medtronic CoreValve

3. Background
• The main limitations of TRA remain
-the small size of the radial artery especially in
women and elderly patients
-the difficulty to use large bore guiding catheter
for complex procedures (e.g. rotablation or
complex left main distal bifurcation)

4. Background
One potential solution is to use the Sheathless
Eaucath GC (Asahi Intecc, Japan) which do not
require any introducer sheath, thus reducing the
equipment size within the RA lumen by ≈ 2-F sizes
From S. Noble et al. Cardiovascular Medicine 2012;15(7-8):218-223

5. Sheathless Eaucath Guiding Catheter
Asahi Intecc, Japan
6.5 F
7.5 F
Specificity of the Sheathless GC inner diameter equivalent to conventional GC whereas
the outer diameter is slighly inferior to that of a 6-F conventional introducer sheath for the
7.5-F Sheathless GC and of a 5-F conventional introducer sheath for the 6.5-F

6. Hydrophylic coating and (radiotransparent) tapered central dilator which facilitates
crossing RA & BA tortuosity as well as catheterisation of small caliber RA (< 2.5 mm)
S. Noble et al. Cardiovascular Medicine 2012;15(7-8):218-223

7. Objective
To compare in a radomized manner transradial
PCI using Sheathless Eaucath GC to standard
GC (Launcher Medtronic)

8. Methods
The 6.5F Sheathless Eaucath GC was used in woman and
the 7.5F Sheathless Eaucath GC in all patients with
complex lesions requiring large bore GC.
Performed at a single tertiary academic center by 3 trained
radialists (MR, RB, SN) between January 2011 and May
2013
Routine administration of verapamil 2.5 mg, hemostasis
using the TR band (Terumo) and dupplex scanning was
planned at day 1

9. Methods
Primary end points were
 procedural success
successful PCI without GC-induced coronary
complications
 procedural safety
absence of hematoma, radial occlusion assessed
by duplex scanning, PCI and vascular
complications

10. Methods
Secondary endpoint was the efficacy of the
Sheathless Eaucath GC considering:
-procedural time
-amount of contrast media
-cross-over to transfemoral approach or additional
techniques (e.g. mother and child technique = telescoping for GC)
5-F 125-cm long diagnostic catheter into
a standard GC
C. Frangos, S. Noble. Cardiovascular Medicine 2011;14(11):315-324

11. Baseline Characteristics (n=233)

12. Angiographic characteristics

13. Successful PCI and Complication rates
Sheathless (114) Guiding catheter (119)
Rate of complications 4 (3.5%) 3 (2.5%)
No PCI complications were directly related to the GC type.

14. Vascular complications
Rate of Dupplex scanning
Dupplex was performed in 85% overall

15. Cross over
233 PCI
Sheathless
114
Crossover to
GC+telescoping
3 (2.7%)
GC TF
1 (0.9%)
Success in 2/3
(66.7%)
No crossover
111 (97.3%)
Guiding
119
Crossover to
Sheathless
10 (8.4%)
GC TF
1 (0.8%)
Success in 9 /10
(90%)
No crossover
108 (91.6%)
Conversion to TFapproach to perform PCI in this cohort of patients with
successful diagnostic exam by transradial approach was < 1%

16. Use of Crossover or telescoping
2.70%
29.40%
technique
Sheatless Launcher guiding
P value < 0.001
Sheathless

17. Cross over + telescoping
233 PCI
Sheathless
114
Crossover
3 (2.7%)
GC+ telescoping
2 (1.7%)
GC TF
1 (0.9%)
No crossover
111 (97.3%)
Guiding
119
Crossover or
telescoping*
35 (29.4%)
Telescoping
35 (100%)
Sheathless
10 ( 28.6%)
GC TF
1 (10%)
Telescoping
success 25/35
(71.4%)
No crossover or
telescoping
84 (70.6%)
*Failure while using telescoping in 10 patients out of 35

18. Subjective assessment of both technique

19. Conclusions
• The use of Sheathless Eaucath GC in TR PCI was
feasible, safe and effective compared to standard
GC.
• Crossover to Sheathless Eaucath GC after
standard GC failure allowed successful TR PCI to
be performed in most patients of the studied
population (i.e. women, men requiring large bore
GC).

20. Conclusions
• Subjectively using a visual assessment scale
- patients reported significantly less pain during
sheathless catheter insertion than conventional
guiding catheter
-operators reported significantly easier arm
crossability while using the sheathless catheters