Trans-Radial Percutaneous Coronary Interventions Using a Sheathless Guiding Catheter-Based Approach
试验速览
- 阶段
- 2 期
- 入组人数
- 250
- 试验地点
- 2
- 主要终点
- Procedural success
研究概览
简要总结
Background:
The transradial approach is increasingly used in percutaneous coronary intervention (PCI) because of lower major access site complications, lower bleeding risk and earlier patient mobilization. According to this trend, in the last couple of years at the University Hospital of Geneva the investigators have changed their practice and currently the transradial approach is the most frequently used for PCI. However, the small diameter of the radial artery remains a major limitation of the technique, especially in women or for complex PCI necessitating larger bore guiding catheters. This may be overcome with sheathless guiding catheters (Asahi, Japan), allowing for a standard inner catheter diameter (6-7 Fr), with an outer diameter equivalent to a standard 5 and 6 Fr introducer sheath.
Aim:
This study is aimed to compare the transradial approach for PCI with a sheathless guiding catheter and with a standard guiding catheter in women and patients with complex lesion necessitating large bore guiding catheters.
Material and methods:
This prospective study will consecutively randomize all women and all men with bifurcation/ostial lesion of a major coronary vessel (i.e. ≈ 120/year) in whom a transradial PCI is attempted. The procedures will be performed either with a standard 6 or 7Fr guiding catheter or with the sheathless 6.5, 7.5 Fr catheters.
End-points:
Successful performance a transradial PCI in all consecutive patients which qualify according to the inclusion criteria (technical feasibility). Establish the proportion of procedures performed with no device-related complications (safety). Analyze in details the technical aspects of the sheathless catheter (efficacy).
Sample size:
The investigators have planed to include in the study ≈ 250 patients in two years. After 1 year of enrollment the investigators will perform an interim analysis and the instigators will decide at that moment, according to the observed end-points, if prolonging the study would be of any scientific value. In this case another 100 patients will be further included in the study.
Enrollment time:
The investigators will start the study as soon the local ethical committee will give us the permission. The investigators plan to start the study in July 2010. The end is expected for July 2012.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- 未提供
排除标准
- •Patients who refused to give their written informed consent.
- •Male patients, in whom PCI can be easily performed with a 6 Fr standard guiding catheter (i.e. no bifurcation or ostial lesion).
- •Patients in whom the radial approach is contra-indicated:
- •Patients with a dialysis arteria-venous fistula or in whom an arteria-venous fistula is planed in the future.
- •Patients with a known radial artery occlusion.
- •Patients in whom a radial approach was unsuccessfully already attempted in the past (anamnestic notion or previous medical record) secondary to a:
- •Challenging vessel anatomy,
- •Vessel tortuosity,
- •Known impossibility to cannulate the coronary ostia by the radial approach.
- •Patients in whom the Allen test results pathological bilaterally:
- •In case of pathological Allen test in one hand the other hand will be tested before choosing the femoral approach.
- •Patients in whom the femoral approach is adopted as primary catheterization approach (at interventionist's discretion), including:
- •Unstable patients (myocardial infarction, cardiogenic shock).
- •Patients necessitating femoral access for an intra-aortic balloon counterpulsation
- •Patients presenting with a double mammary coronary graft (right and left internal mammary utilized for by-pass grafts).
- •Coronary interventions where an extreme good guiding support is mandatory (i.e. PCI of chronic total occlusion, PCI with Rotablator).
- •Particularly risky PCI (e.g., PCI of the left main artery), where the femoral approach may be more comfortable for the operator.
- •Patients requiring a femoral approach for a right heart catheterization.
结局指标
主要结局
Procedural success
时间窗: baseline
Procedural success, defined as a successful delivery of the stent using the sheathless guding catheter, in consecutive patients according to the inclusion criteria (women and bifurcation/ostial lesions) = technical feasibility of the sheathless catheter.
Procedural safety
时间窗: +24 hours
Procedural safety, defined as the proportion of procedures performed in the absence of device-related complications (= safety of the sheathless catheter).
次要结局
- Safety and Tolerability(baseline)
- safety and tolerability(+24 hours)
研究者
Robert F Bonvini
MD
University Hospital, Geneva