Radial versus femoral approach for high-speed rotational atherectomy

The aim of this study was to compare in-hospital outcomes for patients undergoing high-speed rotational atherectomy (HSRA) via the radial and femoral route.

Transradial access is often avoided for HSRA because of concern over limitations on guide catheter size. No studies have compared a radial and femoral approach for HSRA.

This is a retrospective comparison of in-hospital outcomes for 151 consecutive patients (75 radial, 76 femoral) undergoing HSRA.

Significantly smaller diameter guide catheters (6.3 +/- 0.5 Fr vs. 7.1 +/- 0.8 Fr, P < 0.001) and burrs (1.6 +/- 0.2 mm vs. 1.7 +/- 0.2 mm, P = 0.02) were used in the radial compared with the femoral group. Procedural success (93.3% vs. 94.7%, P = 0.75), procedure time (108.7 +/- 30.5 min vs. 112.8 +/- 35.0 min, P = 0.45), and patient radiation exposure (12125 +/- 8373 vs. 12118 +/- 7831 cGy cm(2), P = 1.00) were similar in radial and femoral groups. There was a trend in favor of radial artery access for major access site bleeding complications (0.0% vs. 5.3%, P = 0.12). The incidence of in-hospital death or myocardial infarction was low in both groups.

This study shows that radial artery access is a feasible, safe, and effective approach for HSRA. Overall complication rates are low and radial access may be associated with a lower risk of major bleeding complications compared with a femoral approach.