Kwan Tak W, Ratcliffe Justin A, Huang Yili, Liou Michael, Pancholy Samir, Patel Tejas M
Department of Cardiology, Beth Israel Medical Center, New York, New York 10003, USA.
J Invasive Cardiol. 2012 May;24(5):231-3.
The sheathless approach to transradial percutaneous coronary intervention (PCI) has recently gained popularity among interventionalists. However, technical problems and lack of approved equipment in the United States has limited its applicability. We describe a new approach, balloon-assisted sheathless transradial intervention (BASTI) that can ease the use of 5 Fr sheathless guiding catheters and decrease complication rates.
Twenty-seven consecutive patients undergoing staged elective PCI were enrolled. Radial artery access was obtained using the BASTI method - inflation of a compliant coronary balloon at the tip of the guiding catheter was used to ease the transition of the catheter into the skin. The guidewire and coronary balloon were reused during the PCI. Each of the patients had clinical postprocedure follow-up at radial compression device release, and at 1 day, 7 days, and 30 days. Major adverse cardiac events and access-site complications, including radial artery occlusion (RAO), were documented.
In this consecutive series, we successfully attempted (27/27) BASTIs. There were no difficulties in obtaining radial artery access with the 5 Fr sheathless guiding catheter. Two patients had balloon rupture during initial radial artery access, but were successfully re-attempted with a higher balloon inflation pressure. All patients then underwent successful coronary intervention. There were no adverse events or procedure-related complications at any time period during follow-up.
BASTI is a feasible alternative to conventional techniques and may reduce vascular access-site complications and patient morbidity in a cost-effective manner.
经桡动脉的无鞘经皮冠状动脉介入治疗（PCI）方法最近在介入医生中受到欢迎。然而，技术问题以及美国缺乏获批设备限制了其应用。我们描述了一种新方法，即球囊辅助无鞘经桡动脉介入治疗（BASTI），它可以便于使用5F无鞘导引导管并降低并发症发生率。
连续纳入27例接受分期择期PCI的患者。采用BASTI方法获得桡动脉入路——通过在导引导管尖端充盈顺应性冠状动脉球囊来便于导管进入皮肤。在PCI过程中导丝和冠状动脉球囊可重复使用。每位患者在桡动脉压迫装置松解时以及术后1天、7天和30天进行临床随访。记录主要不良心脏事件和穿刺部位并发症，包括桡动脉闭塞（RAO）。
在这个连续系列中，我们成功尝试了27次BASTI。使用5F无鞘导引导管获得桡动脉入路没有困难。2例患者在初次桡动脉入路时球囊破裂，但通过更高的球囊充盈压力成功再次尝试。然后所有患者均成功进行了冠状动脉介入治疗。随访期间任何时间段均未出现不良事件或与手术相关的并发症。
BASTI是传统技术的一种可行替代方法，并且可能以具有成本效益的方式降低血管穿刺部位并发症和患者发病率。
