Coronary rotational atherectomy via transradial approach: A study using radial artery intravascular ultrasound

Abstract

The use of coronary rotational atherectomy via radial artery (RA) has been limited because of the large diameter of guiding catheters. We studied the feasibility of this approach by sizing the RA by intravascular ultrasound (IVUS) and using 7 Fr (2.31 mm) guiding catheters. Seventeen transradial percutaneous transluminal coronary rotational atherectomy (PTCRA) procedures were performed in 16 patients, mean age 62 +/- 12 years, for a total of 19 vessels treated. The mean RA diameter was 2.9 +/- 0.36 mm and the mean reference diameter of the treated coronary vessels was 2.7 +/- 0.45 mm. The mean coronary percent stenosis was 74% +/- 10%, the mean minimum lumen diameter was 0.76 +/- 0.35 mm, and the mean lesion length was 16 +/- 19 mm. Ten vessels were treated with rotational atherectomy alone, or with adjunctive high pressure balloon angioplasty, achieving an acute lumen gain of 0.8 +/- 0.4 mm (P = 0. 001). Nine arteries had stent implantation in addition to rotational atherectomy, resulting in an acute lumen gain of 2.4 +/- 0.5 mm (P = 0.001). The success rate was 94%. There were no vascular complications. Two patients had a non-Q myocardial infarction. In conclusion, transradial PTCRA when used in conjunction with IVUS of the RA is a safe and feasible procedure in selected cases. This may be an alternative approach of revascularization technique especially for patients with limited vascular access and for those who require early ambulation or early discharge from the hospital.

Rotational Atherectomy for Left Main Coronary Artery Disease in Octogenarians: Transradial Approach in a Tertiary Center and Literature Review

“…In the series of Gioia et al 28 where it was shown that PCI with rotational atherectomy was feasible and safe via transradial access, among the 16 patients there was 1 protected LMCA rotational atherectomy and only 1 case that was performed with a 6 French guiding catheter whereas the remainder were carried out with a 7 French system. Egred et al 29 presented 28 cases of transradial rotational atherectomy PCIs with mean age of 71 AE 9.4 years but there was no LMCA disease.…”

Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures

“…Another issue is regarding the utilization of devices requiring catheters with a larger inner diameter (7-F to 8-F or more). No large-scale trials have been conducted, but some studies have shown the feasibility of 7-F to 8-F transradial procedures (46,47) in selected patients by experienced operators. Of course, these are pioneering reports, and further evaluation is needed with large-scale trials, but technologic improvements associated with increased operator skills may lead to the utilization of transradial access in always more challenging situations without significant harm to patients (48).…”

The Radial Approach: Is This the Route to Take?

“…The safety of transradial access with devices requiring catheters with a larger internal diameter (7F or greater) need to be evaluated in large trials. Initial results are encouraging in selected patients by experienced operators 15–18 …”

“…Initial results are encouraging in selected patients by experienced operators. [15][16][17][18] The procedural failure is rare with modern practice, experience, and availability of the new equipment. There could be several reasons for procedural failure: Firstly, there may be failure to successfully puncture and cannulate the radial artery, because of the small vessel size, tortousity, or spasm.…”