Sheathless transradial intervention using standard guide catheters

Objectives: Our aim was to report our preliminary experience performing complex transradial interventions using a sheathless technique with standard large bore nonhydrophilic guiding catheters. Background: A major limitation of transradial percutaneous coronary intervention (PCI) is the inability to use large guides because of the relatively small size of the radial artery. Methods: We identified consecutive patients who had transradial PCI between September 2009 and March 2010 using large-bore guides (7 or 8 Fr) with a sheathless technique. Results: Ten patients were identified (90% men, mean age 68.8 ± 9.8 years). Indications for PCI were stable angina (60%) and acute coronary syndrome (40%). Treatment was attempted on 15 vessels. Bifurcation lesions were present in six patients. One patient had a chronic total occlusion, one had a saphenous vein bypass graft lesion requiring filter wire placement prior to intervention, and one patient required rotational atherectomy. In the majority of patients (60%) a 7-Fr guiding catheter was used for the intervention; 8-Fr guide catheters were used four patients. PCI was unsuccessful in one vessel; this was a completely occluded obtuse marginal which could not be crossed. There were no radial artery access site complications and in no case was cross-over to a femoral artery access site required. One minor coronary complication occurred. Conclusions: Sheathless transradial PCI using standard large-bore guiding catheters is a safe and effective method for treatment of complex lesions.