Sheathless Radial Approach in Coronary Rotational Atherectomy: Data From Two High-Volume Centers

BACKGROUND Rotational atherectomy (RA) procedures through radial access are known to be associated with reduced major bleeding and access site complications compared with femoral access. New devices such as sheathless guiding catheters (SGC) are a promising alternative to the standard radial approach, with potential benefits for patients and larger operational catheter lumen than corresponding conventional guiding catheters. Given the lack of currently available data in literature, we analysed feasibility and procedural outcome of PCIs with use of RA performed through a trans-radial SGC compared to standard approaches. METHODS We performed a retrospective analysis including all consecutive patients undergoing RA from May 2011 to May 2023 in two Italian high- volume PCI centres. In the standard radial or femoral approach, a 6 to 8 Fr vascular sheath was used. Alternatively, a 7.5 Fr Sheathless EaucathTM guide catheter (SEGC, Asahi Intecc Co., Japan) was used for radial sheathless procedures. RA was performed with the RotablatorTM or, in the last three years, the RotaproTM system (Boston Scientific, Natick, MA, USA). RESULTS Two hundred and twenty-three patients (162 males, mean age 74 ±9.1 years) underwent RA procedures at the participating centres. No cases of femoral access failure were observed. Instead, we observed 15/ 128 failures (11.7%) in the standard radial group and 3/40 (7.5%) in the radial sheathless group. The difference between these two groups was not significant (p=0.336). Procedural time was longer in case of femoral access (on average 110 min) compared with standard radial (98 min) or the SGC radial (100 min) group (p = 0.004). Patients in the femoral group showed a trend towards higher risk of relevant bleeding (BARC ≥3) and vascular complications. Procedural success was similar between groups (p = 0.601).After a median follow-up time of 612 (156-1301) days, Kaplan-Meier curves showed no differences in the overall 3-year survival among the three groups (log-rank: p= 0.757), and between the two radial ones (log-rank: p= 0.503). We had 8/221 (3.6%) cases of target lesion revascularization (5 in the femoral group, 3 in the standard radial group). CONCLUSIONS Our study confirmed that RA procedures through a SGC are as effective and safe as those performed with a standard approach. SGC represent a valuable option to handle complex coronary anatomies and allow to perform RA with suitable backup with all advantages of transradial radial access.