Satoshi Takeshita, Shinji Tanaka, Shigeru Saito, Department of Cardiology and Catheterization Laboratory, Shonan Kamakura General Hospital, Kamakura, Japan.

OBJECTIVES: We sought to determine whether 4-Fr percutaneous coronary intervention (PCI) is associated with technical difficulties that might have an unfavorable impact on procedural parameters.

BACKGROUND: Four-Fr PCI is often associated with difficulties in catheter manipulation, which may lead to greater time consumption and increased dye usage when compared with PCI employing larger guiding catheters.

METHODS: From July 2007 to March 2009, 62 patients underwent 4-Fr PCI. Procedural characteristics were compared between patients who underwent 4-Fr PCI in 2007 (early phase: 31 lesions in 26 patients) and those underwent in 2008 or later (later phase: 40 lesions in 36 patients). Results: Ad-hoc coronary intervention (3% vs. 23%, P < 0.05) and deep-vessel intubation (46% vs. 91%, P < 0.05) were observed less frequently in the late phase than the early phase. Fluoroscopy time (8 �± 6 min vs. 17 �± 15 min, P < 0.05) and the amount of contrast dye used (64 �± 33 mL vs. 90 �± 46 mL, P < 0.05) were significantly reduced in the late phase than the early phase. No access site-related complications were observed in patients in either phase.

CONCLUSIONS: The performance of 4-Fr PCI requires a certain learning curve, following which a reduction in fluoroscopy time and use of contrast dye may be achieved. This improvement in procedural parameters and the low incidence of access site-related complications might allow 4-Fr PCI to serve as a minimally invasive approach for the treatment of coronary artery diseases.

Catheterization and Cardiovascular Interventions, Volume 75 Issue 5, Pages 735 � 739.