ffr-guided coronary intervention to the left anterior ...optiflash xl pressure wire aeris 0.014inch...

FFR-guided coronary intervention to

the left anterior descending artery

with a 4-french guiding catheter

St. Mary’s Hospital, Kurume, Fukuoka, Japan

Takeshi Mikami, Kenji Sadamatsu, Hideki Tashiro

Coronary Intervention History

1977 10Fr

Transfemoral coronary intervention

4Fr Guiding Catheter!

1992 6Fr

Transradial coronary intervention

Slender Catheter Advantages

• Reduce the use of contrast dye about 14%

• Shorten hemostatis time about 1.4 hours

• Lessen any access site complication such

as bleeding and artery occlusion

compared with 6Fr guiding catheters

4Fr guiding catheters

※Takeshita S, Asano H, Hata T, et al. Comparison of frequency of radial artery occlusion

after 4Fr versus 6Fr transradial coronary intervention. Am J Cardiol. 2014; 113: 1986-1989.

CASE

• 52-years-old female

• She was admitted to our hospital because of

heart failure.

• Past History：

ventricular septal defect→operation

hypertension, diabetes mellitus

• Smoking(-)、drinking(-)

Chest X-ray

Electrocardiogram

Echocardiography

Cardiac Computed

Tomography Angiography

Right Coronary Angiography

Left Coronary Angiography

Fractional Flow Reserve Nicorandil 2mg

Diagnostic catheter Guiding catheter

Guiding catheter : HeartrailⅡ BL3.5, 4Fr

Guide wire : PressureWire Aeris

Balloon catheter : Ikazuchi Zero 3.0×15mm

Ballooning

Stenting

Stent : XIENCE Alpine 3.5×18mm

Echocardiography

Optiflash XL

Pressure Wire Aeris

0.014inch

II

0.36mm 1.12mm

0.36mm

Inner Diameter

Before:1.05mm

Now :1.12mm

Conclusion

• 4-french diagnostic catheters are available

measuring fractional flow reserve.

• We can make ad-hoc percutaneous coronary

intervention with 4-french guiding catheters.