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.
