Complex Percutaneous Coronary Interventions by Transradial Approach Using Sheathless Guiding Catheters

Objective: To analyse our single centre experience with sheathless guiding catheters (GC) for complex percutaneous coronary interventions (PCI). Background: Failure of performing transradial approach (TRA) increases with the sheath size used, especially in cases of small and tortuous radial arteries. The use of recently developed sheathless GC may facilitate performance of TRA for complex PCI requiring large-lumen GC. Methods and results: We retrospectively analysed 20 consecutive patients who underwent complex PCI performed by TRA with a Sheathless Eaucath^® GC (Asahi Intecc, Japan). The patients mean age was 68.9 ± 11.3 years. Indications for PCI were ST elevated myocardial infarction in 2 patients (10%), acute coronary syndrome in 4 (20%), and chronic stable angina in 14 (70%). Right TRA was used in all but one case. The 7.5-French (F) sheathless GC was used in all the procedures. Radial and brachial arteries crossing was possible in all cases with no associated procedural or GC-related complications. The number of vessels treated per patient was 1.30 ± 0.47 with 1.70 ± 0.92 stents implanted per vessel. The left main stem was the treated lesion in 9 patients (45%), 5 patients (25%) had complex bifurcation lesions and one (5%) had chronic total occlusion. The remaining 5 patients (25%) had severely tortuous and/or calcified coronary lesions. Rotablation was required in 2 procedures. Mean fluoroscopic time was 20.3 ± 7.5 min and mean volume of contrast media was 254 ± 83 ml. Conclusion: This preliminary experience in complex PCI, suggests that TRA using 7.5-F sheathless GC might be an attractive alternative to transfemoral access using 7-F conventional.