[Slender PCI].

Abstract

Currently the 0.014-inch guidewire is commonly used for coronary intervention and all devices are 0.014 inch-compatible. The size of common guiding catheters is 6Fr. However, PCI requires oral administration of dual antiplatelet agents, and punctured-site complications such as hemorrhage and hematoma occur more frequently with use of a 6Fr guiding catheter compared to a 5Fr guiding catheter. Moreover, 6Fr or larger guiding catheters may cause radial arterial occlusion, although the transradial approach causes less punctured-site complications compared to the transfemoral approach. Recently, 0.010-inch guidewires applicable for the kissing balloon technique (KBT) using a 5Fr guiding catheter and 0.010-inch guidewire-compatible balloons have been developed in Japan, and a 3Fr angiography catheter has also been developed. We refer to these devices as the "slender system", and we have used this system for active treatment of bifurcation lesions and chronic total occlusion (CTO). In this report, we describe angiography using a 3Fr catheter, the KBT using a 5Fr guiding catheter and 0.010-inch guidewires, and treatment of CTO using a 5Fr catheter and 0.010-inch guidewires. For CTO treated using the slender system at our facility, the transradial arterial approach was used in 90.7% of cases, treatment using the slender system alone succeeded in 65.1%, and the overall success rate was 89.5%. Therefore, our results show that complex lesions may be treatable using the slender system, and that not all complex lesions require a 6Fr or larger guiding catheters, a femoral arterial approach, or bilateral guiding catheters.