Safety And Efficacy Of Different Vascular Approach For Percutaneous Coronary Rotational Atherectomy

BackgroundRotational atherectomy(RA) is an important option for treating heavily calcified coronary lesions and undilatable coronary lesions. Traditionally, femoral artery access has been the preferred approach for RA because of the requirement for larger calibre guiding catheters. Studies have shown that the transradial approach for coronary procedures is a safe technique and yields clinical results similar to transfemoral access.And the radial approach virtually abolishes vascular entry site complications and permits a wide range of diagnostic and therapeutic interventions.Hospitalization time was shortened and cost was reduced. At present, transradial approach intervention has become the first choice in most interventional centers. Nowadays, there has been a decreasing need for large burr sizes as RA has evolved to become a prelude to stent implantation; therefore, transradial access may provide an attractive option for interventional cardiologists. However, there is little data in the current literature to support a role for radial access for the application of RA in China. Some small case series of transradial RA have been published, but no comparative studies have been reported.Radial artery access may result in a lower incidence of access site bleeding complications following RA compared with a femoral approach. We sought to compare the safety and efficacy of patients undergoing RA via the radial and femoral approach.ObjectiveThe aim of this study was to evaluate the safety and efficacy of percutaneous coronary rotational atherectomy via the radial and femoral approach.MethodsFrom October 2013 to February 2016, 124 consecutive CHD patients with heavily calcified coronary lesions or undilatable lesions who underwent rotational atherectomy in our hospital were enrolled in this retrospective study.Patients were divided according to the vascular approach into two groups: transradial approach intervention(TRI) and transfemoral approach intervention(TFI).We compared the success rates of RA and stenting,rates of complication during perioperations,average duriation of hospitalization, MACE during hospitalization.Statistical analysis was performed using SPSS version 13.0. Resultswe retrospectively observed 124 CHD patients who underwent rotational atherectomy in our hospital. 1. The proportion of males who underwent RA through radial approach is higher than that of females(76.8% vs. 58.8%, p=0.034). The complexity of coronary artery lesions in the two groups was comparable, and there was no statistical significance in the proportion of ACC/AHA type B2/C and three vessels lesions. LAD has a higher incidence of atherosclerosis and calcification than the RCA, LCX and LM stem. The rest baseline datas were comparable in both group. 2. The proportion of 7Fr guided catheter in the radial artery group was lower than that of the femoral artery group(32.5% vs 82.9%, p<0.01). The proportion of burrs used with diameter less than 1.5mm was 87.1%. there was no statistical significance in burr/artery ratio(0.49 + 0.057 vs 0.49 + 0.051, p=0.820) and the utilization rate of IABP. The utilization rate of temporary pacemaker in the radial artery group was lower than that of the femoral artery group(8.4% vs 24.4%, p=0.043). 3. There were no differences in success rate of RA and stenting, perioperation complications, MACE during hospitalization, Procedural success, procedure time in radial and femoral groups. Transradial rotational atherectomy was associated with a decrease in access site complications(1.2% vs 12.2%, p=0.008) and average time hospitalization(7.33±2.07 days vs 9.93±3.42 days, p<0.01). No in-hospital death or myocardial infarction was observed in both groups. ConclusionThis study shows Rotational atherectomy using a smaller burr( burr / vessle ratio at about 0.5) can treat heavily calcified coronary lesions effectively. Radial artery access is a feasible, safe, and effective approach for rotational atherectomy compared with femoral artery access. Overall complication rates are low and radial access may be associated with a lower risk of bleeding complications compared with a femoral approach. Transfemoral approach is an indispensible approach to substitute transradial approach.