Slender approach and sheathless techniques

Most radial arteries cannot accommodate 7- and 8-French introducer sheaths for large-bore percutaneous coronary intervention without overstretch. In addition to being uncomfortable, radial artery overstretch is associated with spasm and higher rates of procedure-related radial artery occlusion. Methods for the transradial interventionist to overcome the limitation of radial artery-sheath size mismatch include both sheath-based and sheathless approaches. In this article we discuss a variety of techniques that can be used to minimize radial artery stretch for straightforward and complex coronary procedures.