Mayo Experience Supports Sheathless Transradial Angioplasty

December 7, 2010—The Society for Cardiovascular Angiography and Interventions (SCAI) announced that cardiologists from the Mayo Clinic performed sheathless transradial percutaneous coronary intervention (PCI) to remedy complex lesions, achieving a 90% success rate with no radial complications. Standard guiding catheters were used during the procedure. The success overcomes the last hurdle to greater adoption of transradial PCI in the United States, stated SCAI.

Aaron M. From, MD, et al published findings from their preliminary experience in SCAI's Catheterization and Cardiovascular Interventions (2010;76:911–916).

According to SCAI, transradial angioplasty is increasing in use due to quick patient recovery and lower complications at the access site; however, a major limitation of transradial PCI is the inability to use large guiding catheters because of the small size of the radial artery. To explore this issue, the investigators performed transradial PCI using a sheathless technique with standard guiding catheters.

The investigators identified 10 patients who had undergone transradial angioplasty for stable angina (60%) and acute coronary syndrome (40%) between September 2009 and March 2010. Treatment was attempted on 15 vessels, and complex bifurcation lesions were present in six patients.

SCAI noted that although current medical evidence reports the use of guiding catheters with hydrophilic coating and long central dilators during sheathless transradial PCI, these devices are currently not available in the United States. In the current study, all procedures were performed using 7-F (six patients) or 8-F (four patients) Vista Brite Tip nonhydrophilic-coated guiding catheters (Cordis Corporation, Bridgewater, NJ).

“We showed the safety and feasibility of performing complex PCI through large-bore guiding catheters from the radial artery using a sheathless technique,” commented lead investigator Charanjit S. Rihal, MD. “This affords patients all the benefits of radial access for even the most complex coronary procedures."

The investigators reported that the series' results showed that PCI was successful in all but one patient who had a completely obstructed obtuse marginal artery that could not be crossed. One minor coronary complication was reported—a small vessel dissection within the lesion of interest, which was covered with a stent. This patient was asymptomatic and was dismissed in good health after one night of observation. Furthermore, no deaths occurred during the follow-up period (median of 27 days), and there were no episodes of radial artery spasm upon removal of the guide or any postprocedure occlusions in the radial artery. Crossover to the femoral artery was not needed in any of the cases.

Dr. Rihal concluded, “Sheathless transradial PCI using standard large-bore guiding catheters is a safe and effective method for treating complex lesions.”