Slender Sheath/Guiding Catheter Combination vs. Sheathless Guiding Catheter for Acute Coronary Syndrome: A Propensity-Matched Analysis of the Two Devices

Tsuyoshi Isawa, Kazunori Horie, Taku Honda, Masataka Taguri, Norio Tada, Tsuyoshi Isawa, Kazunori Horie, Taku Honda, Masataka Taguri, Norio Tada

Abstract

A Glidesheath slender (Terumo, Tokyo, Japan) and a sheathless Eaucath guiding catheter (Asahi Intecc, Nagoya, Japan) are two major slender devices utilized in percutaneous coronary intervention (PCI). This study aimed to investigate the differences in access-site complications between these devices in PCI for acute coronary syndrome (ACS). A total of 1108 consecutive patients who underwent transradial PCI for ACS were enrolled. Transradial PCI was performed using either a 7-Fr Glidesheath slender/7-Fr guiding catheter combination (Glidesheath group) or a 7.5-Fr sheathless guiding catheter (Sheathless group); 1 : 1 propensity score matching was performed, and 728 patients (364 in each group) were included in the propensity-matched population. In the matched patients, univariate analysis revealed that the Glidesheath group had less radial artery occlusion (RAO) at 30 days (Glidesheath: 1.4% vs. Sheathless: 4.1%, odds ratio (OR) = 0.33, 95% confidence interval (CI) = 0.12-0.91, p=0.039), whereas no significant between-group differences were observed in severe radial spasm (Glidesheath: 1.4% vs. Sheathless: 1.9%, OR = 0.71, 95% CI = 0.23-2.22, p=0.58) or access-site major bleeding (Glidesheath: 1.4% vs. Sheathless: 1.6%, OR = 0.83, 95% CI = 0.26-2.71, p=1.00). Multivariate analysis revealed that the choice for Glidesheath was significantly associated with less RAO (OR = 0.32, 95% CI = 0.11-0.93, p=0.036). In conclusion, 7-Fr Glidesheath slender/7-Fr guiding catheter combination is obviously more advantageous than 7.5-Fr sheathless guiding catheters for decreased risk of RAO. The potential low risk of RAO in our findings supports the adoption of the 7-Fr Glidesheath slender sheath/7-Fr guiding catheter combination in transradial PCI for ACS.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Copyright © 2020 Tsuyoshi Isawa et al.

Figures

Figure 1
Figure 1
Comparison of the outer diameter and inner lumen diameters among the Glidesheath slender sheath, sheathless guiding catheter, and conventional sheath (illustration prepared by the authors with reference to the Glidesheath slender® sheath and Sheathless Eaucath® information brochures). “Glidesheath slender” denotes a Glidesheath slender sheath, and “Sheathless” denotes a sheathless guiding catheter. ID, inner lumen diameter; OD, outer diameter.
Figure 2
Figure 2
Flowchart of study design and patient selection criteria. ACS, acute coronary syndrome; PCI, percutaneous coronary intervention.
Figure 3
Figure 3
Sheathless transradial percutaneous coronary intervention procedure. (a) A central dilator is introduced into a guiding catheter. (b) A 4-Fr conventional sheath is inserted into the radial artery. (c) Following introduction, the sheath is exchanged for a sheathless guiding catheter connected to a supplied central dilator over a 0.035-inch wire. (d) A silicon-based stopper is linked to the proximal shaft of the sheathless guiding catheter and anchored to a surgical drape using forceps to avoid slippage.

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