Slender PCI: Extremely Minimally Invasive Percutaneous Coronary Intervention

215 Pages·2020·11.425 MB·English

by  Fuminobu Yoshimachi

Slender PCI
Extremely Minimally Invasive
Percutaneous Coronary
Intervention
Fuminobu Yoshimachi
Editor
123
Slender PCI
Fuminobu Yoshimachi
Editor
Slender PCI
Extremely Minimally Invasive Percutaneous
Coronary Intervention
Editor
Fuminobu Yoshimachi
Department of Cardiology
Tokai University Hachioji Hospital
Hachioji
Tokyo
Japan
ISBN 978-981-15-3776-9 ISBN 978-981-15-3777-6 (eBook)
https://doi.org/10.1007/978-981-15-3777-6
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Preface
Percutaneous coronary intervention (PCI) is less invasive than the bypass surgery.
Minimally invasive treatment is one of the essences of PCI. It is reasonable to select
PCI as a less invasive treatment, considering the similar outcomes obtained for
revascularization. However, in recent years, numerous physicians are satisfied with
the current situation. They are not trying to further reduce the invasiveness of
PCI. They may be merely following the current procedure and recommendations in
guidelines and they misunderstand the minimally invasive strategy of this approach.
Guidelines are based on the evidence from previous studies; thus, they are useful
in standardizing the procedure. However, guidelines do not provide new ideas or
tips and tricks for the management of individual patients. We wish to offer more
comfortable circumstances and less invasive treatment for our patients beyond the
recommendations of guidelines. In other words, we have to practice beyond guide-
lines. Moreover, large academic conferences or excellent medical publications pro-
vide major directions towards the treatment of a disease, but do not effectively
disseminate sufficient information for the management of individual patients.
We the physicians should not neglect the need to improve our skills. Each inter-
ventional cardiologist has numerous tips for the management of patients, which
should be shared with the relevant community worldwide. Such sharing of informa-
tion may improve the procedure of PCI in the future.
We have formed an organization called “Slender Club Japan.” The term “Slender”
was selected based on the use of a small-diameter catheter for a less invasive PCI
strategy. Currently, we study all minimally invasive treatments for revascularization
rather than limiting our investigation to merely slender catheters. The aim is to
reduce exposure, usage of contrast agent, pain or discomfort to patients, procedure
time, bleeding complications, and other invasiveness to patients. Moreover, the
working conditions and costs of doctors and healthcare staff also pose a burden to
the society; thus, improvements in these areas are crucial.
Although it is difficult to address all the topics related to less invasive PCI, this
book contains numerous important pieces of information. After reading this book
you will notice that the daily practice of PCI is not a simple routine work. It is
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vi Preface
important to make an effort to shift toward a slightly less invasive direction every
day. In time, your treatment will be very different from your previous practice.
Performing minimally invasive treatment is not linked to a higher salary or
awards/recognition from society. The satisfaction of patients and colleagues is one
of the rewards for interventional cardiologists practicing minimally invasive
PCI. Even if no one is aware of our efforts for minimally invasive treatment, the
smile of patients and their families indicates the great success of our strategy.
Naturally, circumstances differ between hospitals or countries, and you may not
be able to exactly replicate the methods described in this book. The true minimally
invasive treatment is in you. It is a kind feeling for the patient. This book is the key
to accessing this approach.
Please enjoy reading this book. It will be your first step toward minimally inva-
sive treatment.

Tokyo, Japan Fuminobu Yoshimachi
Acknowledgments
Colleagues from Japan and around the world have contributed to this book entitled
Slender PCI to freely spread information regarding minimally invasive percutane-
ous coronary intervention (PCI). This publication targets established international
interventionalists as well as local Japanese physicians in any region of Japan. In
addition, we believe that Slender PCI is an appropriate source of information for
patients worldwide.
I wish to thank all colleagues who participated in the production of this book and
also for their hard work. Although many of our friends were not directly involved in
writing this book, they contributed substantially through collaboration and discus-
sion regarding minimally invasive intervention. The content of this book is an accu-
mulation of tips and tricks that are not presented in large academic meetings or
published in leading journal articles.
Thank you all once again!
We hope this book can be a guide for young physicians who are interested in
minimally invasive intervention and the well-being of their patients. Such young
and ambitious physicians possessing new ideas will lead the future developments in
angioplasty.
A little effort and ingenuity are required for Slender PCI, but those are not diffi-
cult. We can see the patient’s smile at the price of our effort. Also, it is not necessary
for the patient and his family to know this good conduct. When treatment is over, at
the meeting room drinking coffee with other physicians and members of the para-
medical team, you can say “We performed extremely less invasive PCI for the
patient today!” It is wonderful!
We recommend consulting Slender PCI for the happiness of our patients,
patients’ families, and all of us.
We hope this field will develop further, and we do our best toward this goal.
Finally, we have the web site of Slender Club Japan (https://slenderclubja-
pan.com), which is a study group for minimally invasive strategy. We hold an
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viii Acknowledgments
annual meeting in Japan. If you wish to know more, please join us. You may
discover an unbelievable field and obtain information for your angioplasty room
and strategy.
Tokyo, Japan Fuminobu Yoshimachi
Contents
1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Fuminobu Yoshimachi
2 What Is Slender PCI? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Motomaru Masutani
3 Evidence for Slender Percutaneous Coronary Intervention . . . . . . . . 7
Takashi Matsukage
4 Less Invasive Intervention: From a Forearm Radial
to Distal Radial Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Shigeru Saito
5 Distal Transradial Access for Arterial Angiography
and Interventions: An Overview of Knowledge . . . . . . . . . . . . . . . . . . 23
Ferdinand Kiemeneij
6 Ultimate Less Radial Artery Occlusion Hemostasis Method
on Slender PCI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Ivo Bernat
7 Distal Radial Approach for ST Elevation
Myocardial Infarction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Akihiko Takahashi
8 Backup Support of Slender Percutaneous Coronary
Intervention Guiding Catheter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Fuminobu Yoshimachi
9 Radial Artery Puncture and Hemostasis . . . . . . . . . . . . . . . . . . . . . . . 69
Sandeep Nathan and Rajeev Anchan
10 Usefulness of Low-Concentration Contrast Medium
in Coronary Angiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Takashi Harada
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11 Minimum Contrast PCI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Naoki Masuda
12 Usefulness of Fractional Flow Reserve Measurement
with the Four FRench Diagnostic Catheter (FFRFFR) . . . . . . . . . . . . 113
Masanori Kanehachi and Katsuhiko Masamura
13 4 Fr. Guiding Catheter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Takashi Matsukage
14 3 Fr Diagnostic Catheter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Yoshiaki Katahira
15 Sheathless Slender in the United Kingdom . . . . . . . . . . . . . . . . . . . . . 145
Mamas A. Mamas, Ahmad Shoaib, and Karim Ratib
16 Slender Sheathless in Japan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
Yoshitoki Takagawa
17 Slender PCI for Bifurcation Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Kaoru Sakurai
18 Use of Slender PCI in Undilatable Calcified Coronary Lesions . . . . . 179
Akihiko Takahashi
19 Slender PCI for Chronic Total Occlusion: Microchannel Tracking
Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Motomaru Masutani
20 Histological Insight into the Pathology of Coronary Chronic Total
Occlusion and Intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Masataka Nakano
21 Slender CTO: 1P1G and Chameleon Technique . . . . . . . . . . . . . . . . . 197
Ryuichi Kato and Ryo Oyama
22 CTO: Retrograde Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
Fuminobu Yoshimachi