Balloon-assisted sheathless transradial intervention (BASTI) using 5 Fr guiding catheters.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

BASTI is a feasible alternative to conventional techniques and may reduce vascular access-site complications and patient morbidity in a cost-effective manner.