SWITCHing to Distal RaiL: a tracking technique for rotational atherectomy procedures-short-term outcomes and impact...

Despite the preference for transradial access (TRA) in percutaneous coronary interventions (PCI), many operators still use large-bore guiding catheters through the transfemoral approach (TFA), especially in complex cases. This study evaluated the feasibility, safety, and efficacy of the Distal RailTracking (DRT) technique, a sheathless approach via distal radial access (DRA), and investigated its impact on clinical practice.

The multicenter SWITCH D-RIL study enrolled patients who required treatment of severely calcified coronary disease by rotational atherectomy, and compared those who underwent PCI before (pre-DRT, n = 97) and after (post-DRT, n = 99) DRT was adopted as the primary approach.

Procedural success rates without access site crossover were similar between groups. No significant differences were found in periprocedural complications, in-hospital and 30-day major adverse cardiovascular events, and access- and non-access-related major bleedings. The post-DRT group exhibited a significantly higher use of large-bore guiding catheters (97.1% vs 31.7%). Overall, DRA was used in 90.5% of cases in the post-DRT group, with TFA accounting for 9.5%; the pre-DRT group primarily employed conventional TRA (82.2%), with the remaining cases involving TFA and 1 transbrachial access. The post-DRT group demonstrated increased usage of burrs larger than 1.5 mm (51.4% vs 13.9%) and additional calcium modifying tools (42.9% vs 24.8%).

The DRT technique demonstrated feasibility, safety, and efficacy in treating severely calcified coronary disease. This study highlights the reliability of DRA, even when large bore guiding catheters are necessary, emphasizing its potential to provide a safer approach while ensuring radial artery preservation.