Trans-radial coronary intervention (TCI) using 5-Fr versus 6-Fr guiding catheters in the setting of acute coronary syndrome (ACS)

Background: As in any vascular access the size of guiding catheter is an operator preference. Although multiple studies showed the use of 5-Fr versus 6-Fr guiding catheters for Transradial coronary intervention (TCI) have similar vascular safety profile and can be performed safely and successfully with both of them, the data comparing the 5-Fr vs 6-Fr guiding catheters for TCI in terms of fluoroscopy time, procedure time and contrast amount in the setting of ACS is limited. We conducted this study to compare the use of 5-Fr versus 6-Fr guiding catheters for TCI in the settings of ACS. Method: Our study is a single center, retrospective cohort study designed to compare the use of 5-Fr versus 6-Fr guiding catheters for TCI in the setting of ACS. In the period between July 2014 and July 2015, all patients who had previously undergone PCI with at least one stent being placed, utilizing a radial access, and using a 5Fr or 6Fr guiding catheter were included. No exclusion criteria were applied. The study was approved by Marshall University’s institutional review board. Results: There was a significant reduction in the volume of contrast medium used with the 5 Fr group compared to the 6 Fr group (130.66 +/- 3.46 ml vs. 166.25 +/- 10.05 ml in the 5 and 6 Fr groups, respectively; p < 0.001), fluoroscopy time (12.62 +/- 0.50 min vs. 16.61 +/- 1.28 min in the 5 and 6 Fr groups, respectively; p = 0.005) and there was also significant reduction in the procedure time in the 5 Fr group (38.74 +/- 1.27 min vs. 46.03 +/- 2.86 min in the 5 and 6 Fr groups, respectively; p = 0.023). Conclusion: TCI in the settings of ACS is safe and feasible, whether using 5 Fr or 6 Fr catheters. Our study concluded that using 5 Fr catheters for TCI could be preferred for patients presenting with ACS due to lower amount of contrast medium used and less fluoroscopy and procedure time. However, this is a single center retrospective study, so we suggest that large randomized controlled studies are needed.