Abstract
Background
The mother and child technique with a deep-seated 4F Kiwami catheter has been reported to be effective for delivering stents to complex lesions.
Objectives
To assess the feasibility and efficacy of a novel 4.5F child catheter for deep insertion and stent deployment into the distal coronary artery for the treatment of complex lesions.
Method
We retrospectively evaluated 51 consecutive patients, who underwent percutaneous coronary intervention between January 2011 and December 2013, using a 4.5F CoKatte catheter after stent delivery failure using the conventional procedures. We evaluated the procedure success, need for an additional anchor balloon technique, and complications related to the deep insertion.
Results
Stent delivery to the intended lesion was successful in all cases. For advancement and subsequent deep intubation of the catheter, 42 lesions required the additional anchor balloon technique. No complications, including proximal dissection, air embolism, and severe ischemia, were observed in relation to the deep insertion of the catheter.
Conclusion
Percutaneous coronary intervention with the novel 4.5F catheter is a safe and effective method, which can facilitate stent delivery to a complex coronary lesion.
1
Introduction
In percutaneous coronary intervention (PCI), the key to a successful procedure is the delivery of the coronary stent; however, deployment of the stent can be difficult at times owing to several conditions, including lack of backup support of the guiding catheter and unfavorable lesion characteristics, such as severe calcification or tortuous configuration of the vessel. Those conditions are especially critical for the transradial PCI approach, which is usually performed with 6F or smaller guiding catheters. To cope with the lack of the backup support, the mother-child technique was proposed using a 5-in 6F guiding catheter , which can achieve equivalent backup support as a 7F or 8F guiding catheter. Further, 4F straight child catheters (the so-called “coronary accessors”) that can access the distal target lesion directly have been developed and are reported to be effective for stent delivery . More recently, a 4.5F straight hydrophilic catheter with enhanced trackability has been developed and used clinically in Japan. We aimed to assess and report the feasibility and efficacy of the novel 4.5F catheter for the delivery of coronary stents.
2
Methods
2.1
Patient population and the PCI procedure
Between January 2011 and December 2013, we performed 1699 PCI cases. Of these, 51 patients underwent PCI with support of the CoKatte catheter (Asahi Intecc Co., Ltd., Seto, Japan). This technique was used, at the operator’s discretion, after balloon catheter or stent delivery failure during the conventional procedure using a 6F guiding catheter. During the PCI procedure, unfractionated heparin was used for anticoagulation, and the activated clotting time was maintained above 300 seconds.
2.2
CoKatte catheters
The CoKatte catheter is a straight catheter with an outer diameter of 1.5 mm and a length of 120 cm, and it is compatible with a 6F guide catheter. The unique feature of this catheter is the hydrophilic coating over almost the entire length of the catheter (105 cm) to reduce the friction during its advancement through the mother catheter and the vessel wall. Additionally, the edge of the catheter tip is polished into a round shape ( Fig. 1 ). Furthermore, the shaft of the catheter is similar to the one in the Corsair® Microcatheter (Asahi Intecc Co., Ltd) that is made for channel tracking of the collateral vessels of the coronary artery, and thus, has excellent trackability and may help prevent ischemic events when inserted deeply into tortuous vessels.
2.3
Evaluation criteria
We retrospectively evaluated the following parameters: success in stent delivery, application of the anchor balloon technique for advancement of the catheter, complications related to deep insertion, such as vessel dissection and air embolism, and incidence of ischemia-induced arrhythmia during insertion of the catheter. Quantitative variables are expressed as mean ± standard deviation.
2
Methods
2.1
Patient population and the PCI procedure
Between January 2011 and December 2013, we performed 1699 PCI cases. Of these, 51 patients underwent PCI with support of the CoKatte catheter (Asahi Intecc Co., Ltd., Seto, Japan). This technique was used, at the operator’s discretion, after balloon catheter or stent delivery failure during the conventional procedure using a 6F guiding catheter. During the PCI procedure, unfractionated heparin was used for anticoagulation, and the activated clotting time was maintained above 300 seconds.
2.2
CoKatte catheters
The CoKatte catheter is a straight catheter with an outer diameter of 1.5 mm and a length of 120 cm, and it is compatible with a 6F guide catheter. The unique feature of this catheter is the hydrophilic coating over almost the entire length of the catheter (105 cm) to reduce the friction during its advancement through the mother catheter and the vessel wall. Additionally, the edge of the catheter tip is polished into a round shape ( Fig. 1 ). Furthermore, the shaft of the catheter is similar to the one in the Corsair® Microcatheter (Asahi Intecc Co., Ltd) that is made for channel tracking of the collateral vessels of the coronary artery, and thus, has excellent trackability and may help prevent ischemic events when inserted deeply into tortuous vessels.
2.3
Evaluation criteria
We retrospectively evaluated the following parameters: success in stent delivery, application of the anchor balloon technique for advancement of the catheter, complications related to deep insertion, such as vessel dissection and air embolism, and incidence of ischemia-induced arrhythmia during insertion of the catheter. Quantitative variables are expressed as mean ± standard deviation.
3
Results
This clinical study included 51 consecutive patients who underwent PCI using the 4.5F mother-child technique. The demographic data of the patients are provided in Table 1 . The mean age of the patients was 74.5 ± 9.6 years, and 27 were men (53.0%). Target vessels were located in the left anterior descending artery in 13 patients; in the left circumflex artery in 7; in the RCA in 27, including those with an anomalous origin; and in the SVG in 4. The transradial approach was performed in 41 patients. Chronic total occlusion was present in 6 lesions, and most of the lesions were type C lesions ( Table 1 ). Seven lesions required lesion preparation with Rotablator® (SCIMED, Boston Scientific Corp.) before stent delivery following advancement of the child catheter.
| Patient characteristics (n = 51) | N (%) |
|---|---|
| Age, Y, mean ± SD | 74.5 ± 9.6 |
| Male sex | 27 (53.0) |
| Diabetes | 23 (45.1) |
| Hypertension | 33 (64.7) |
| Hyperlipidemia | 22 (43.1) |
| Previous myocardial infarction | 14 (27.5) |
| Previous PCI | 15 (29.4) |
| Previous bypass surgery | 3 (5.9) |
| Extent of vessel disease | |
| 1 | 15 (29.4) |
| 2 | 9 (17.6) |
| 3 | 27 (52.9) |
| LVEF, %, mean ± SD | 56.4 ± 15.9 |
| Lesion characteristics | |
| Lesion site | |
| LAD | 13 (25.5) |
| LCX | 7 (13.7) |
| RCA | 27 (52.9) |
| Bypass graft | 4 (7.8) |
| Lesion AHA/ACC type | |
| A | 0 (0) |
| B1 | 3 (5.9) |
| B2 | 19 (37.3) |
| C | 29 (56.9) |
| CTO | 6 (11.8) |
| ACS | 7 (13.7) |
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