Abstract 21155: Rotational Atherectomy via the Radial Artery Route is Safe With Equivalent Procedural Success Rates to the Traditional Femoral Route
Introduction: Rotational atherectomy (RA) is useful in modifying calcified plaque during PCI. RA can make the difference when it is difficult or impossible to pass standard balloons/stents or may be used at the outset in patients with calcium burden. Traditionally RA has been carried out using French sheaths ≥7F via the femoral approach as this allows passage of larger burr (>2.0mm). Radial PCI is becoming more common and our aim was to investigate whether the radial route with sheath size limited to 6/7F would offer equivalent rates of procedural success.
Methods: Characteristics, and outcome variables of all patients undergoing PCI at the University Health Network are entered into a prospective database. Patients who underwent RA between January 2001 and March 2010 were studied. Data on in-hospital mortality, need for urgent CABG or transfusion were also collected.
Results: A total of 86 cases of RA were performed (72% male, age 70.4[41–96]). RA was chosen at the outset in 54% of cases. Patients were high-risk (41% diabetics, 56% CCS class III/IV, 14% previous CABG). There was no significant difference in the clinical characteristics of the patients who underwent femoral versus radial RA. Radial artery RA was carried out in 33 (38.4%) cases. There was a significant difference in sheath size (femoral 7[6–8] vs. radial 6[6–7], p=0.002), but no difference in the choice of 1st or 2nd burr(1.25 vs. 1.75, p=NS). There was a significant difference in the rate of transvenous pacing being more common in femoral (12 vs.1, p=0.014). 22 cases were done as an emergency and were more likely to be done via the femoral route (p=0.002). Stents were deployed in 95% of cases. No difference in stent type was noted overall however BMS were more common than DES in the first half of the cases (p=0.018). There was 1 death (tamponade), 1 patient required urgent CABG and 3 blood transfusion. All complications occurred in patients who underwent RA via the femoral approach. Radial access was not associated with failure of stent deployment.
Conclusions: We have presented a robust database for RA and have shown that radial access is safe and as good as the more traditional femoral access. Our data do not suggest an increase rate of failure using the radial route despite the fact smaller sheath sizes were utilized.
- © 2010 by American Heart Association, Inc.