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Comparison of 6 and 7 French guiding catheters for percutaneous coronary intervention: Results of a randomised trial with a vascular ultrasound endpoint
Author(s) -
Juergens Craig P.,
Hallani Hisham,
Leung Dominic Y.C.,
Crozier John A.,
Robinson Jacqui T.C.,
Lo Sidney,
Hopkins Andrew P.
Publication year - 2005
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.20534
Subject(s) - medicine , vascular closure device , conventional pci , percutaneous coronary intervention , randomized controlled trial , pseudoaneurysm , surgery , femoral artery , clinical endpoint , percutaneous , arteriovenous fistula , radiology , cardiology , complication , myocardial infarction
Objective : To perform a randomized, ultrasound controlled trial to define the procedural and clinical advantages and limitations of 6 French (Fr) compared with 7 Fr transfemoral coronary intervention in the stenting era. Background : The use of 7 Fr guiding catheters may facilitate Percutaneous Coronary Intervention (PCI), but may be associated with increased vascular complications when compared with 6 Fr catheters. Methods : Patients undergoing PCI considered suitable for either a 6 or 7 Fr sheath and guiding catheter system were included. All vascular sheaths were removed with assisted manual compression. Femoral vascular ultrasounds were performed prior to hospital discharge and interpreted by a vascular surgeon blinded to treatment assignment. The primary endpoint was a composite of significant vascular complications including major haematoma, retroperitoneal haematoma, pseudoaneurysm, arterio–venous fistula, or femoral venous or arterial thrombosis. Results : During the study, 414 patients (mean age 61 ± 11 years, 27% females) were randomly assigned to 6 Fr or 7 Fr sheath groups. The incidence of major vascular complications was 5.7% in the 6 Fr group and 3.9% in the 7 Fr group ( P = 0.383). There was no significant difference in procedural or angiographic success between the groups. The use of contrast volume was higher in the 7 Fr group (157 ± 58 ml vs. 144 ± 58 ml; P = 0.029). There was a trend toward better operator satisfaction with the 7 Fr guide ( P = 0.08). Conclusions : This prospective, randomized trial indicates no reduction in major peripheral vascular complications with the use of smaller guiding catheters in PCI. There was less contrast used in the 6 Fr group, which may benefit some patient subsets, however operators tended to prefer the larger 7 Fr system. The target coronary anatomy and need for complex device intervention should mandate the choice of guiding catheter size, not a perceived impact on vascular complications. © 2005 Wiley‐Liss, Inc.