Author + information
- Gregory Sgueglia1,
- Gaetano Gioffrè1,
- Antonella De Santis1,
- Fabrizio D'Errico1,
- Francesco Summaria1 and
- Achille Gaspardone1
Transradial intervention offers important advantages over transfemoral percutaneous coronary intervention (PCI), including higher patient’s comfort, reduce bleeding and potential for overall better outcomes. However, identified predictors of radial artery spasm or small size may influence selection of vascular access when ad hoc PCI is the default treatment. However, recently reported striking reduction in death with transradial access in ACS urges operators to identify new approaches that allow implementing TRI in a growing proportion of patients. We aimed at exploring the feasibility and safety of “the one small catheter only” (TOSCO) strategy for urgent coronary angiography and primary PCI in patients with ST elevation myocardial infarction (STEMI).
This series included unselected STEMI patients with symptom onset <3 hours, no history of bypass surgery and a palpable radial artery who underwent urgent coronarography angiography with a 5 French guiding catheter able to canulate both coronary arteries. The expected non-culprit artery was imaged first, then the same catheter was used to perform primary PCI in the culprit vessel. Thrombus aspiration was always avoided while predilation was implemented in every procedure.
Overall 30 patients (mean age 62±13 years, 19 men) were included in this report. Location of STEMI was anterior in 14 (47%), lateral in 6 (20%) and inferior in 10 (33%) patients. Guiding catheter curves were of the following type: Amplatz Left in 5 (17%), Kimny in 15 (50%) and Barbeau in 10 (33%) patients. The TOSCO procedure was successful in all but 3 (10%) patients in who a further catheter was required. Two of them presented an anomalous origin of the right coronary artery and the third one a particularly narrow aorta. In one patient with refractory hypotension an intra-aortic balloon pump was inserted through the right femoral artery and the procedure completed according to the initial strategy. Angiographically-assessed myocardial reperfusion was optimal in 25 (83%) patients. No access-related and major procedural complication was recorded. Access-to-balloon time was significantly lower in the last 10 patients compared to the 10 (5.3±3.4 min vs. 7.2±3.6 min, p=0.05).
This concept series demonstrates the feasibility and safety of using only one 5 French guiding catheter for performing both urgent coronary angiography and primary PCI in unselected patients with STEMI. Based on this first series, the TOSCO strategy appears to require a short learning curve to finely master dedicated catheter curves and optimize procedural time.
CORONARY: Acute Myocardial Infarction