Transradial Approach of Alcohol Septal Ablation Using a Sheathless Guiding Catheter: A Feasibility Study

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Surgery

Background:

• Alcohol septal ablation (ASA) conventionally uses the femoral artery, posing risks of bleeding and vascular complications.
• The transradial approach offers a potential alternative with a lower complication rate.
• Sheathless guiding catheters with hydrophilic coatings may mitigate radial artery issues like occlusion and spasm.

Purpose of the Study:

• To evaluate the feasibility and safety of alcohol septal ablation (ASA) utilizing a transradial approach.
• To assess the efficacy of a sheathless guiding catheter in reducing vascular complications during ASA.
• To determine the impact of this approach on left ventricular outflow tract pressure gradients and patient functional status.

Main Methods:

• A prospective study involving 14 patients with hypertrophic obstructive cardiomyopathy undergoing ASA via transradial access.
• Left radial artery access was used for the sheathless guiding catheter; right radial access monitored left ventricular pressure.
• Temporary pacemaker insertion was performed via the right jugular vein.

Main Results:

• A procedural success rate of 93% (13/14 patients) was achieved.
• Significant reduction in left ventricular outflow tract pressure gradient from 128 mm Hg to 16 mm Hg at 30-day follow-up (P=.01).
• Improvement in New York Heart Association functional class from median II to I (P=.01), with no access-site complications.

Conclusions:

• The transradial approach with a sheathless guiding catheter is a feasible and safe option for alcohol septal ablation.
• This technique demonstrates significant efficacy in improving hemodynamic and functional parameters in patients with hypertrophic obstructive cardiomyopathy.
• The absence of access-site complications highlights the safety profile of this minimally invasive approach.