Dedicated Sheathless System Versus Sheath-Based Approach for Transradial Percutaneous Coronary Intervention:...

Area of Science:

• Cardiovascular Interventions
• Medical Device Technology
• Interventional Cardiology

Background:

• Transradial access (TRA) is preferred for percutaneous coronary intervention (PCI) due to better patient outcomes.
• Challenges in TRA include radial artery spasm (RAS) and occlusion (RAO).
• Sheathless approaches have been developed to address these TRA challenges.

Purpose of the Study:

• To evaluate the efficacy and safety of sheathless systems versus conventional sheath-based techniques in TRA PCI.
• To compare outcomes such as radial artery spasm, access site crossover, bleeding, and occlusion.
• To analyze data stratified by study design and sheath type.

Main Methods:

• Systematic review and meta-analysis of 8 studies (3 RCTs, 5 OBS) involving 6380 patients.
• Comparison of sheathless and sheath-based approaches in TRA PCI.
• Pooled data using random-effects models and assessed heterogeneity.

Main Results:

• The sheathless approach significantly reduced radial artery spasm (RAS) (OR 0.31) and access site crossover (OR 0.34).
• These benefits were particularly noted in the conventional sheath subgroup.
• No significant differences were observed in access-related bleeding, radial artery occlusion (RAO), procedural success, or procedural metrics.

Conclusions:

• The sheathless system is a safe and effective alternative for TRA PCI.
• It reduces RAS and crossover without increasing RAO or bleeding risk.
• Potential benefits include enhanced procedural efficiency and patient comfort, especially in challenging anatomies.