Fraser Douglas, Mamas Mamas A
Manchester Heart Centre, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Trust, Manchester, UK,
Curr Cardiol Rep. 2015 Jun;17(6):47. doi: 10.1007/s11886-015-0597-5.
The lumen of the radial artery in many patients is smaller than the outer diameter of a 6F radial sheath frequently leading to procedural pain, trauma to the radial artery and contributing to radial occlusion. Chronically, neointima formation reduces luminal size further, limiting successful re-intervention in some patients. Sheathless guides are 1-2F sizes smaller than corresponding sheaths and so may potentially reduce radial artery trauma. Although not currently recommended for routine use, the 6.5F Asahi EauCath Sheathless guide has a lower profile than a 5F sheath and the same inner lumen as a 6F guide and has been shown to be especially useful for interventional procedures requiring 6F techniques in patients with small radial arteries. Similarly, the 7.5F Asahi EauCath has a lower profile than a 6F sheath and the same inner lumen as a 7F guide and is useful for procedures requiring a large bore guide catheter. Alternatives include the MediKit Works 5F sheathless system and long dilators designed to allow the sheathless introduction of conventional guides. The recently approved 'Flip' dilator is now available outside Japan; however, experience is currently limited.
许多患者的桡动脉管腔小于6F桡动脉鞘的外径，这常常导致操作时疼痛、桡动脉损伤，并促使桡动脉闭塞。长期来看，新生内膜形成会进一步减小管腔大小，限制了部分患者再次成功进行介入治疗。无鞘导管比相应的导管鞘小1-2F尺寸，因此可能会减少桡动脉损伤。虽然目前不推荐常规使用，但6.5F旭化成EauCath无鞘导管的外形比5F导管鞘更小，内腔与6F导管相同，已被证明对桡动脉细小的患者进行需要6F技术的介入操作特别有用。同样，7.5F旭化成EauCath的外形比6F导管鞘更小，内腔与7F导管相同，对需要大口径导管的操作很有用。其他选择包括MediKit Works 5F无鞘系统和设计用于无鞘引入传统导管的长扩张器。最近获批的“Flip”扩张器目前在日本以外地区也有供应；然而，目前经验有限。
