PCI & AimRadial 2018 | FFR using 4Fr catheters: Can Slender Technique Work Here? - Ian C Gilchrist
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PCI & AimRadial 2018 | FFR using 4Fr catheters: Can Slender Technique Work Here? - Ian C Gilchrist
![icg2018
4 French Feasibility
Yadav, Gilchrist. JACC 2014;64(11_S)
Pop Test
Pulse-Duplicator
Area 4-F catheter = 3.14 mm2
Area 0.014” wire = 0.10 mm2
Mean difference = 0.006 [-0.052-0.064]
Legalery, et al. Am J Cardiol 2003;91:1075–1078
4F Diagnostic vs 7F Guide FFR
∆(4FFFR-7FrFFR)
µFFR](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
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PCI & AimRadial 2018 | FFR using 4Fr catheters: Can Slender Technique Work Here? - Ian C Gilchrist
- 1. FFR using 4Fr catheters: Can Slender Technique Work Here? Ian C Gilchrist, MD, FACC, FSCAI Professor of Medicine Penn State’s Hershey Medical Center Heart & Vascular Institute Hershey, PA USA
- 2. icg2018 4 French Feasibility Yadav, Gilchrist. JACC 2014;64(11_S) Pop Test Pulse-Duplicator Area 4-F catheter = 3.14 mm2 Area 0.014” wire = 0.10 mm2 Mean difference = 0.006 [-0.052-0.064] Legalery, et al. Am J Cardiol 2003;91:1075–1078 4F Diagnostic vs 7F Guide FFR ∆(4FFFR-7FrFFR) µFFR
- 3. icg2018 4F vs 6F Diagnostic Catheter FFR 61 patients 4F FFR FFR 0.70-0.90 Cut point 0.80 6F FFR Paired Comparison Moriyama N, et al. COFFEE Trial. JACC I 2018;;11:412-14
- 4. icg2018 Example: Taking it a Down a Notch 50 year old woman with recurrent atypical pain RCA stent last year via left radial out of town Stress test was equivocal Small, light framed woman Definitely wants a wrist approach again Right radial 5F sheath Option for intervention icg 2017
- 5. icg2018 0.035” wire stopped at sheath Right forearm angiogram via sheath High origin of radial from brachial artery High-branching radial & spasm
- 6. icg2018 Switched to 4F LCA- 4F JL3.5 RCA- 4F JR4.0
- 7. icg2018 Not Sure of RCA at Stent stent Options? 1. Go down under (groin)? 2. Contalateral radial? 3. Ulnars? icg 2017
- 8. icg2018 FFR- 4 French Multipurpose icg 2017
- 9. icg2018 General Coronary Set-Up Hydrostatic transducer (Ao) Electronic transducer (Co) Computer FFR, iFR, etc Flushed Catheter Clean Signal No Catheter Damping Wire Normalized Calibrated Positioned
- 10. icg2018 Effects of Catheters in Different Coronary Ostia Toth, J Am Coll Cardiol. 2016;68(7):742-753. 5-F 6-F 7-F 4-F Catheter Area 4-F catheter = 3.14 mm2 Area 0.014” wire = 0.10 mm2 4F 0.014” wire
- 11. icg2018 Lumen Longitudinal Effects THROMBIN CONTRAST WHAT HAPPENS TO THE PULSE WAVEFORM? Ideal pressure wave Ideal pressure wave central obstacle Lumen1 Lumen2
- 12. icg2018 4F Catheter Characteristics Diagnostic only in US Can’t directly do PCI if needed Interface between wire & catheter wall may add friction Thermo-stability poor
- 13. icg2018 4-F Technique Less forgiving than larger French Use fresh catheter & rapidly introduce wire Meticulous FFR/iFR technique needed • Confirm lumen is well flushed • Transducer or catheter is not-damped • Dicrotic notches on tracing? Lack of immediate interventional capacity may temper patient choice
- 14. icg2018 Improvements Needed Better understanding of wire/internal catheter interface to improve coeffiecent of friction 4-F guides or equivalent (FFR catheters?) Potential for smaller catheters if sensor also placed on distal catheter Goal: Use of the smallest diameter access into the radial artery required for diagnosis will maximize long-term radial artery function