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Purpose: To assess the feasibility and safety of the 7 French (Fr) Glidesheath Slender for complex transradial (TR) percutaneous coronary interventions (PCI)., Background: The TR approach is increasingly used worldwide for coronary and peripheral vascular interventions. However, the small size of the radial artery remains an important limitation for the use of large-bore guiding catheters (>6 Fr), restricting thereby the treatment of highly complex lesions through the TR approach. The 7 Fr Glidesheath slender (Terumo, Tokyo, Japan) is a new dedicated radial sheath with a thinner wall and hydrophilic coating. It combines an inner diameter compatible with any 7 Fr guiding catheter and an outer diameter smaller than current 7 Fr sheaths., Methods: Prospective multicenter registry of complex TR PCI cases using the 7 Fr Glidesheath Slender to determine the procedural success, rates of vascular complications, radial spasm, and radial artery occlusion (RAO)., Results: A total of 60 patients were included. Procedural success was 97% with only one access-site crossover. The use of a 7 Fr guiding catheter was indicated for the treatment of highly complex coronary lesions including distal left main (LM) disease (n = 20), complex non-LM bifurcation lesions (n = 16), chronic total occlusion (n = 15), and severely calcified vessels requiring rotational atherectomy (n = 10). There were three vascular access-site complications (4.7%) including two moderate (type II) local hematoma and one uncomplicated guiding catheter-induced brachial artery dissection. None of the patients experienced major bleeding. The occurrence of radial spasm was reported in seven patients (11%). Doppler ultrasound imaging of the radial artery at 1 month was available in 62 of 64 radial access with three cases of RAO (4.8%)., Conclusions: Use of the 7 Fr Glidesheath slender for complex coronary interventions is feasible and associated with a high rate of procedural success and a low rate of vascular complications. These favorable results need be confirmed in larger multicenter studies. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

Objective: To determine the impact of ostial guiding catheter disengagement during measurement of fractional flow reserve (FFR) in patients with an isolated proximal left anterior descending artery (LAD) stenosis., Methods: Measurements of FFR were performed in 21 patients with an isolated intermediate lesion of the proximal LAD. Proximal aortic pressure (Pa), distal post stenotic pressure (Pd), and Pd/Pa were recorded at baseline, after at least 90 sec of intravenous (IV) adenosine infusion with the guiding catheter still engaged in the coronary ostium (Pa1 , Pd1 , FFReng ), and after at least 30 sec of guiding catheter disengagement back to the aorta (Pa2 , Pd2 , FFRdis )., Results: The average value of Pd/Pa at baseline was 0.92 ± 0.04. After 110 ± 8 sec of IV adenosine infusion, FFReng was 0.81 ± 0.07, which decreased to 0.77 ± 0.08 (FFRdis ) after 38 ± 6 sec of guiding catheter disengagement. The mean ΔFFR (FFReng  - FFRdis ) was 0.05 ± 0.04. As compared to baseline values, the mean change in FFR values was significantly increased after disengagement of the guiding catheter (Pd/Pabaseline  - FFRdis vs. Pd/Pabaseline  - FFReng , 0.15 ± 0.05 vs. 0.10 ± 0.04, P < 0.0001). Before guiding catheter disengagement, eight patients (38%) had an FFR value ≤ 0.8. Following disengagement of the guiding catheter, the new FFR values decreased below 0.8 in six additional patients (28%), with subsequent change in treatment strategy., Conclusions: During FFR assessment of isolated intermediate proximal LAD lesions, guiding catheter disengagement is associated with a decrease in mean FFR values. In patients with FFR values lying close to the treatment threshold, this can have an impact on treatment strategy., (© 2014 Wiley Periodicals, Inc.)

The transradial (TR) approach for coronary angiography and intervention is increasingly used worldwide because of several advantages such as reduced bleeding and vascular complications. During TR procedures, aggressive catheter manipulation in the setting of complex and tortuous arterial anatomy can lead to catheter kinking and entrapment. Several percutaneous retrieval techniques using either homolateral radial access or femoral access have been described previously. We demonstrate, for the first time, the use of a sheathless guide catheter as a rescue technique to successfully retrieve a severely kinked and entrapped diagnostic catheter during TR access. © 2014 Wiley Periodicals, Inc., (© 2014 Wiley Periodicals, Inc.)

Objective: The aim of this study is to evaluate the feasibility and safety of the Glidesheath Slender in routine transradial (TR) coronary angiography and intervention., Background: In recent years, The TR approach has gained in popularity because of several advantages such as reduced vascular access site complications and immediate patient mobilization. Procedural success has been further improved through technological innovations and the development of less invasive devices. The Glidesheath Slender (Terumo, Tokyo, Japan) is a new dedicated radial sheath with a thinner wall and hydrophilic coating. It combines an inner diameter compatible with 6Fr guiding catheter with an outer diameter close to current 5Fr sheaths. Its use has the potential to decrease invasiveness and access site complications during TR procedures., Methods: A total of 114 consecutive patients undergoing TR coronary angiography and/or PCI using the Gidesheath Slender were included in a prospective single-center feasibility and safety study., Results: Procedural success was 99.1% with only one case requiring conversion to femoral access. There were six minor hematomas but none of the patients experienced major vascular complications. The rate of symptomatic radial spasm was 4.4%. No case of major sheath kinking was noted. Doppler ultrasound examination of the radial artery at 1 month follow-up was available in 113/114 patients with only one case of radial artery occlusion (RAO) (0.88%)., Conclusions: Routine use of the Glidesheath Slender for TR coronary angiography and interventions is safe and feasible with a high rate of procedural success and a low rate of RAO. © 2013 Wiley Periodicals, Inc., (© 2013 Wiley Periodicals, Inc.)

Transcatheter aortic valve implantation (TAVI) is a highly specialized technique offering a new therapeutic option to patients at high risk for conventional surgery. However, despite continuous improvements in operators' expertise and device technology, complications associated with this catheter procedure are not uncommon. We report an unusual case of late contained rupture of the aortic annulus, combining a para-aortic false aneurysm and a ventricular septal defect, after the placement of an Edwards Sapien prosthesis., (Copyright © 2012 Wiley Periodicals, Inc.)