High-speed rotational atherectomy during transradial percutaneous coronary intervention

There has been an exponential growth in the number of percutaneous coronary intervention (PCI) procedures carried out via the transradial route. Traditionally, high-speed rotational atherectomy (HSRA) has been performed through 8 and 9 Fr catheters, which has limited its use during radial PCI.

To review the applicability and outcomes of HSRA as a primary debulking tool during radial PCI.

Case-note review and retrospective analysis of all patients undergoing HSRA during transradial PCI. Twenty-nine consecutive procedures in 28 patients were performed between January 2005 and April 2007.

Eighteen (64%) of the patients were males, and the mean age was 71 +/- 9.4 years (46-89). Three procedures were urgent, and 14 proceeded to HSRA, though this was not the initial strategy. The majority of procedures, 23 (79.3%), were carried out using a 6 Fr system, and a 7 Fr system was used in the remainder of cases. There were 15 lesions in the left anterior descending artery, 11 in the right coronary artery and 3 in the left circumflex. Lesion classification was type C in 21, and type B2 in 5. HSRA was carried out successfully in all cases, with uneventful subsequent stent deployment. A 1.5 mm burr was used in 25 lesions, 1.25 mm in 4, and 1.75 mm in 2 lesions. The vessel diameter was 2.7 +/- 0.5 mm (range 2.25-4.0 mm), and the mean length of stents used was 23.5 +/- 6.7 mm (range 18-63 mm). The mean procedure time was 94 +/- 35 minutes (range 50-180). CK-MB postprocedure was available in 26 patients; no patients experienced a greater than two-fold rise in CK-MB. There were no major procedural complications. One patient had evidence of minor brachial artery dissection when the guide catheter was upsized to 7 Fr, but there were no sequelae. Another patient had evidence of pericardial effusion after the procedure that was treated successfully with pericardial drain with no consequences. There were no major adverse cardiac events.

Transradial HSRA can be carried out safely with good results. In this series, the procedure was not the initial strategy in the majority of patients, but allowed successful revascularization. Use of the transradial route should not preclude consideration of HSRA in suitable patient subgroups.