Optimal Sheath for Single-Access Percutaneous Coronary Intervention With Impella CP Hemodynamic Support

Abstract

Background

Single-access percutaneous coronary intervention (PCI) with the Impella CP (Abiomed) has increased in prevalence. Despite this, the optimal PCI sheath remains unknown. We characterized the optimal 7F PCI sheath using the single-access technique.

Methods

The outer diameter measurement of the sheaths was performed using a Keyence 2-axis laser micrometer (Keyence). The force needed to insert the sheath and the torqueability of the guide catheter were assessed using the Mark-10 M5i Advanced Digital Force/Torque Indicator (Mark-10 Corporation) on a simulated single-access setting in a simulated skin pad. The sample size was determined to be 5 sheaths for each test.

Results

The BRITE TIP 11 cm (Cordis), BRITE TIP 35 cm (Cordis), and Destination sheath (Terumo) had the largest outer diameters; the Prelude IDeal (Merit Medical) and Terumo Glidesheath (Terumo) had the smallest outer diameters. The Glidesheath was easiest for insertion/removal, followed by the Prelude IDeal and Impella Low Profile (LP) Companion sheath (Abiomed). The Impella LP Companion, Prelude Roadster (Merit Medical), and Destination sheaths allowed for the best torqueability and lowest force to remove the guide catheter. The longer Impella LP Companion sheath did not impact torqueability, but the removal force increased by 50% compared with the shorter Impella LP Companion sheath.

Conclusion

The Impella LP Companion sheath demonstrated the best torqueability and least effort in advancing the guide catheters, while the Prelude Roadster and Destination also performed well on these metrics. The Prelude IDeal and Glidesheath were good options for single-access because of their smaller outer diameters and hydrophilic coating and were easiest for insertion/removal through the 14F LP sheath.