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Title: | Enhancing Guidewire Efficacy for Trans-radial Access: The EAGER Randomized Controlled Trial | Authors: | Bland, Adam ;Meere, William ;Mikhail, Philopatir ;Chuah, Eunice ;Redwood, Eleanor ;Ferreira, David;Howden, Nicklas ;Perkovic, Adam ;Saunders, Samantha ;Kelty, Amy ;Kull, Anthony ;Hill, Andrew ;Spina, Roberto ;Sarathy, Kiran ;May, Austin N ;Parkinson, Michael ;Ishak, Mark ;Collins, Nicholas;Boyle, Andrew;William, Maged ;Jeyaprakashk, Prajith ;Ford, Tom | Affliation: | Central Coast Local Health District Gosford Hospital |
Issue Date: | 31-Aug-2024 | Source: | Online ahead of print | Journal title: | Circulation. Cardiovascular Interventions | Department: | Cardiology | Abstract: | Background: The 1.5mm 'Baby J' hydrophilic narrow J tipped wire is a development of the standard 0.035" 3mm J tipped peripheral guidewire, designed to improve efficiency of transradial coronary procedures by safely navigating small caliber radial arteries to the aorta. There is currently a lack of evidence comparing the procedural success and safety of different peripheral guidewires used in transradial cardiac procedures. We compared the efficacy and safety of a narrow J tipped hydrophilic 0.035" wire (intervention - Radifocus™ 'Baby J' guidewire, TERUMO Co., Tokyo, Japan). versus standard fixed core (FC) 0.035" J wire (control). Methods: Investigator initiated, blinded, Australian, multicenter randomized trial in patients undergoing clinically indicated coronary angiography and/or PCI. Randomized 1:1 via sealed envelope method to use either the control or the intervention guidewire. The primary endpoint (technical success) was defined as gaining aortic root access with the randomized guidewire. Results: 330 patients were randomized between October 2022 - June 2023 (median age 69 years, 36% female, BMI 29 kg/m²). The primary endpoint was achieved more frequently in the intervention group [96% v 84%; mean difference 12% (95% CI 5.7-18.3); p<0.001]. Women assigned to the control wire experienced a higher failure rate compared to men (31% v 8% in men; p<0.001). Fluoroscopy time was significantly shorter in the baby J group (median 344 versus 491 seconds; p=0.024). The main mechanisms of failure using the control wire were radial artery spasm (15/26; 57%) and subclavian tortuosity (5/26; 19.2%). There were no differences in overall procedure times, MACE, or vascular complications between guidewires. Conclusions: A narrow 1.5mm J tipped hydrophilic guidewire resulted in greater technical success and reduced fluoroscopy time compared to the standard 3mm J tip non-hydrophilic guidewire. The guidewire is safe and demonstrated key incremental benefits for the trans-radial approach particularly in women. | URI: | https://hdl.handle.net/1/2706 | Pubmed: | https://pubmed.ncbi.nlm.nih.gov/39215512 | Publicaton type: | Journal Article | Keywords: | Cardiology Cardiovascular Disease |
Study or Trial: | Randomized Controlled Clinical Trial/Controlled Clinical Trial |
Appears in Collections: | Cardiology |
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