Safety and feasibility of directional coronary atherectomy with transradial approach using an 8Fr sheathless guiding catheter

This study aimed to assess the safety and feasibility of the transradial approach (TRA) using the 8Fr sheathless guiding catheter (GC) in directional coronary atherectomy (DCA). This retrospective analysis included all consecutive patients who underwent percutaneous coronary intervention with DCA from April 2021 to March 2024 in three cardiovascular centers. During the study period, 194 DCA procedures were performed. Of these, 51 included the TRA using an 8Fr sheathless guiding system, whereas the remaining 143 included the conventional transfemoral approach (TFA) system. Primary outcomes were the vascular access site complication (VASC), defined as a bleeding complication in the perioperative period, retroperitoneal hematoma, pseudoaneurysm, large hematoma around the puncture site, or access vessel occlusion rate, and technical success rates, defined as delivery of the DCA catheter to the target lesion and plaque debulking to < 60% of the %plaque area. Although there were some bias such as the lower lesion complexity in the TRA group, the VASC rate was significantly lower in the TRA group than in the TFA group (p = 0.02) and both approaches had > 80% technical success rates. In conclusion, DCA with TRA using an 8Fr sheathless GC may be a safe and feasible method.