Ota Tsuyoshi, Sawada Takahiro, Koide Masahiro, Iwasaki Masamichi, Nakamura Koichi, Matsuoka Yoichiro, Terao Yuya, Ito Tatsuro, Shirai Takeaki, Okajima Katsunori, Kadotani Makoto, Onishi Yoshio, Hirata Ken-Ichi
Department of Cardiology, Kakogawa Central City Hospital, 439 Honmachi, Kakogawacho-Honmachi, Kakogawa, 675-8611, Hyogo, Japan.
Department of Cardiology, Kyoto Okamoto Memorial Hospital, Kyoto, Japan.
Sci Rep. 2025 Jul 14;15(1):25392. doi: 10.1038/s41598-025-11349-4.
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.
本研究旨在评估在定向冠状动脉斑块旋切术（DCA）中使用8Fr无鞘引导导管（GC）经桡动脉途径（TRA）的安全性和可行性。这项回顾性分析纳入了2021年4月至2024年3月在三个心血管中心接受DCA经皮冠状动脉介入治疗的所有连续患者。在研究期间，共进行了194例DCA手术。其中，51例采用8Fr无鞘引导系统经桡动脉途径，其余143例采用传统经股动脉途径（TFA）系统。主要结局指标为血管入路部位并发症（VASC），定义为围手术期出血并发症、腹膜后血肿、假性动脉瘤、穿刺部位周围大血肿或入路血管闭塞率，以及技术成功率，定义为将DCA导管送达靶病变且斑块减容至<斑块面积的60%。尽管存在一些偏倚，如TRA组病变复杂性较低，但TRA组的VASC发生率显著低于TFA组（p = 0.02），且两种途径的技术成功率均>80%。总之，使用8Fr无鞘GC经桡动脉途径进行DCA可能是一种安全可行的方法。
