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Page 2 of 10 Dall’Ara et al. Vessel Plus 2023;7:26 https://dx.doi.org/10.20517/2574-1209.2023.107

and bleeding complications was found in the femoral group.

Conclusion: Sheathless transradial vascular access is a viable option when performing RA during complex PCI
procedures, tending to result in fewer failures than the standard transradial approach and reduced bleeding and
vascular complications compared to the femoral method.

Keywords: Rotational atherectomy, coronary calcium, percutaneous coronary intervention, vascular access,
sheathless guiding catheter

INTRODUCTION
There is compelling evidence of reduced overall mortality, major adverse cardiovascular events, and
vascular complications with the use of radial rather than femoral access for percutaneous coronary
interventions (PCIs) . Although the femoral artery has traditionally been chosen to perform coronary
[1]
rotational atherectomy (RA), the contemporary approach is based on mindfully selecting the vascular access
according to the required burr size and operator experience . Data from the British Cardiovascular
[2]
Intervention Society registry show the feasibility of RA through the radial artery, and a reduction in major
bleeding and vascular complications compared with femoral access in a large cohort . Indeed, a standard
[3]
radial approach has relatively few limitations, such as cases of radial artery occlusion, calcific narrowing,
tortuosity of the supra-aortic vessels, and the need for a large bore catheter or increased backup.

Key elements in choosing the guiding catheter for RA are aorto-ostial disease, backup and burr size
requirement, and vascular access status . Of note, a thin-walled hydrophilic sheath or a sheathless guiding
[2]
catheter (SGC) are alternative options to the standard radial approach in complex procedures, allowing the
previously listed limitations to be overcome . Few reports describe cases of RA through an SGC . One
[4]
[5]
single-center analysis of 135 patients undergoing RA reported similar outcomes between procedures
performed via standard femoral and radial access using an SGC . In addition to maintaining the advantages
[6]
of a transradial approach over the femoral one, the use of an SGC could conceivably increase procedural
feasibility compared to the standard radial approach, thanks to its ability to navigate unfavorable vascular
anatomies. Considering the paucity of data, we analyzed RA outcomes according to vascular access route
and use of an SGC.

METHODS
This is a retrospective longitudinal analysis including two high-volume Italian PCI centers: the Cardiology
Unit of the “Morgagni-Pierantoni” Hospital in Forlì, and the Cardiology Unit of the “Gaetano Martino”
University Hospital in Messina.

Patient selection
All consecutive patients who underwent coronary revascularization with the use of RA between May 2011
and May 2023 were included, irrespective of clinical presentation.

Data collection
The study was approved by the local ethics committee (CE-ROM) and submitted to the regional web-based
platform on health research in Emilia-Romagna (SIRER). Clinical, imaging, and follow-up data were
obtained from hospital and outpatient clinical records. Data were processed anonymously in accordance
with local privacy procedures. This study was conducted in line with the declaration of Helsinki and the
national principles regarding clinical trials.