Safety and feasibility of directional coronary atherectomy with transradial approach using an 8Fr sheathless guiding...

Area of Science:

• Cardiovascular Interventions
• Interventional Cardiology
• Vascular Access Techniques

Background:

• Directional coronary atherectomy (DCA) is a percutaneous coronary intervention (PCI) used for plaque removal.
• Vascular access site complications (VASCs) are a concern in PCI procedures.
• The transradial approach (TRA) is an alternative to the transfemoral approach (TFA) for vascular access.

Purpose of the Study:

• To evaluate the safety and feasibility of using an 8Fr sheathless guiding catheter (GC) with the TRA for DCA.
• To compare vascular access site complication rates between TRA and TFA in DCA procedures.

Main Methods:

• Retrospective analysis of 194 DCA procedures performed between April 2021 and March 2024 across three cardiovascular centers.
• Comparison of 51 procedures using TRA with an 8Fr sheathless GC against 143 procedures using the conventional TFA system.
• Assessment of primary outcomes including vascular access site complications and technical success rates.

Main Results:

• The TRA group demonstrated a significantly lower vascular access site complication rate compared to the TFA group (p=0.02).
• Both the TRA and TFA groups achieved technical success rates exceeding 80%.
• Potential bias noted includes lower lesion complexity in the TRA group.

Conclusions:

• Directional coronary atherectomy (DCA) utilizing the transradial approach (TRA) with an 8Fr sheathless guiding catheter (GC) appears to be a safe and feasible option.
• TRA may offer a reduced risk of vascular access site complications compared to TFA for DCA.
• Further research may be warranted to confirm findings in more complex lesion subsets.