Sheathless transradial intervention using standard guide catheters.

Area of Science:

• Cardiovascular Interventions
• Vascular Access Techniques
• Interventional Cardiology

Background:

• Transradial percutaneous coronary intervention (PCI) is limited by radial artery size, restricting large guide use.
• Large bore guiding catheters are often necessary for complex coronary interventions.
• Sheathless techniques offer a potential solution to overcome radial artery size limitations.

Observation:

• A retrospective analysis of 10 patients undergoing complex transradial PCI with large-bore (7-8 Fr) sheathless guiding catheters was performed.
• Indications included stable angina and acute coronary syndrome, with complex lesions such as bifurcations and chronic total occlusions.
• Procedures involved 15 vessels, with one case of rotational atherectomy and filter wire use for a bypass graft lesion.

Findings:

• The sheathless technique was successful in 14 out of 15 vessels, with no radial artery access site complications reported.
• No crossover to femoral access was required, and only one minor coronary complication occurred.
• A 7-Fr guiding catheter was used in 60% of patients, with 8-Fr used in four patients.

Implications:

• Sheathless transradial PCI with standard large-bore guiding catheters is a safe and effective approach for complex coronary interventions.
• This technique expands the utility of the transradial approach, potentially reducing complications and improving patient outcomes.
• Further research may validate this method for a broader range of complex PCI cases.