Clinical effectiveness and radial artery remodeling assessment via very-high-frequency ultrasound/ultra biomicroscopy after applying slender 7Fr sheath for transradial approach in left main bifurcation disease

Abstract

Objective

To explore the clinical effect and radial remodeling of transradial slender 7 Fr sheath for left main bifurcation disease (LM bifurcation).

Methods

From January 2018 to September 2019, 236 patients with LM bifurcation undergoing transradial percutaneous coronary intervention (PCI) from two heart centers were divided into slender 7 Fr sheath group (n = 127) and 6 Fr sheath group (n = 109). Quantitative coronary angiography (QCA) and very high-frequency ultrasound/ultra biomicroscopy (VHFUBM) were used to assess the clinical effect and radial remodeling of transradial sheath.

Results

Slender 7 Fr sheath group had a higher preoperative distal bifurcation angle (67.271 ± 22.886) than 6 Fr group (55.831 ± 20.245) (p < .05). Post-PCI QCA results showed significant differences in minimum lumen diameter at proximal left anterior descending artery (LAD) and left circumflex artery (LCX) between two groups (p < .05). There were no significant differences in target vessel myocardial infarction, target vessel revascularization, death and major adverse cardiocerebrovascular events (MACCE) at 30-day and 1-year follow-up between two groups (p>.05). No significant differences were observed in radial artery diameter (RAD), intimal-medial thickness (IMT) and radial artery injury at 24-h and 90-day follow-up between two groups.

Conclusion

With larger main and side branch diameter, larger angle of bifurcation and higher SYNTAX score, transradial slender 7 Fr sheath obtained similar clinical effects as 6 Fr sheath without increasing the occurrence of adverse events. Similar follow-up RAD, IMT and radial artery injury were observed. Therefore, slender 7 Fr sheath has safety and feasibility in applying to transradial LM-Bifurcation PCI.

Keywords:

• Left main bifurcation
• slender 7Fr sheath
• very high-frequency ultrasound/ultra biomicroscopy
• quantitative coronary angiography
• remodeling process

Transparency

Declaration of funding

This work was supported by a grant from National Key Research and Development Program of China [2017YFC0908800], Beijing Municipal Administration of Hospitals’ Mission Plan [SML20180601].

Declaration of financial/other relationships

Authors declared no conflicts of interest. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

YX and YZ conceived and designed the study. YX, YZ and YL provided materials and samples. YX, YL, HS, BZ, QZ, YC, ZZ, QG and JY collected and assembled the data. YX, YZ, BZ, YL and HS analyzed and interpreted the data. All authors read and approved the final manuscript.

Acknowledgements

None reported.