Wellington Hospital, Wellington, New Zealand.
J Interv Cardiol. 2023 Feb 22;2023:2434516. doi: 10.1155/2023/2434516. eCollection 2023.
We aimed to assess the effectiveness of the sheathless Eaucath guiding catheter (SEGC) in overcoming severe spasm.
Radial spasm is a frequent challenge in transradial access (TRA) and can be difficult to manage.
We performed a prospective observational study of 1000 consecutive patients undergoing coronary angiography with or without percutaneous coronary intervention. Patients with primary transfemoral access (TFA) or primary use of a sheathless guide catheter were excluded. Patients who developed angiographically confirmed severe spasm were treated with further sedation and vasodilators. If the conventional catheter would still not advance, it was exchanged for a SEGC. The primary endpoint was the successful passage of the SEGC through the radial with successful engagement of the coronary artery in patients with resistant severe spasm.
Primary TFA access was used in 58 (5.8%) and primary radial access with a SEGC in 44 (4.4%) patients. Of the remaining 898 patients, 888 (98.9%) had a radial sheath successfully inserted. Of these, 49 (5.5%) developed severe radial spasm with inability to advance the catheter. Following treatment with additional sedation and vasodilators, the severe spasm resolved in 5 (10.2%) patients. Passage of a SEGC was attempted in the remaining 44 patients with resistant severe spasm. Passage of the SEGC and engagement of coronary arteries were successful in all cases. There were no complications related to use of the SEGC.
Our findings suggest that use of the SEGC for resistant severe spasm is highly effective, safe, and may reduce the need for conversion to TFA.
评估无鞘 Eaucath 导引鞘（SEGC）在克服严重痉挛方面的有效性。
桡动脉痉挛是经桡动脉入路（TRA）中常见的挑战，且可能难以处理。
我们对 1000 例连续接受冠状动脉造影术（无论是否进行经皮冠状动脉介入治疗）的患者进行了前瞻性观察研究。排除了初次经股动脉入路（TFA）或初次使用无鞘导引导管的患者。对经血管造影证实存在严重痉挛的患者，给予进一步镇静和血管扩张剂治疗。如果常规导管仍不能前进，则将其更换为 SEGC。主要终点是在对顽固的严重痉挛患者，SEGC 成功穿过桡动脉并成功进入冠状动脉。
58 例（5.8%）患者采用初次 TFA 入路，44 例（4.4%）患者采用初次桡动脉入路并使用 SEGC。在其余 898 例患者中，888 例（98.9%）桡动脉鞘成功插入。其中，49 例（5.5%）患者出现严重桡动脉痉挛，无法推进导管。在给予额外镇静和血管扩张剂治疗后，5 例（10.2%）患者的严重痉挛得到缓解。在其余 44 例对严重痉挛有抵抗的患者中尝试使用 SEGC。在所有情况下，SEGC 均成功穿过并进入冠状动脉。使用 SEGC 无相关并发症。
我们的研究结果表明，SEGC 用于顽固的严重痉挛非常有效、安全，且可能减少转为 TFA 的需求。
