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Access-site complications of transradial percutaneous coronary intervention using sheathless guiding catheters for acute coronary syndrome: a prospective cohort study with radial ultrasound follow-up

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The advantages of sheathless guiding catheters over the conventional approach using sheaths in percutaneous coronary intervention (PCI) regarding access-site complications, particularly ultrasound-diagnosed radial artery occlusion (RAO), remain unknown. The present study investigated the incidence of access-site complications of transradial primary PCI using sheathless guiding catheters in acute coronary syndrome (ACS). This prospective study evaluated access-site complications in 500 patients with ACS undergoing sheathless transradial primary PCI. Doppler ultrasound evaluation of the radial arteries was performed 2 and 30 days after the procedure. Sheathless guiding catheters (7.5-Fr) were used in 91.0% of the patients. The procedural success rate was 98.4%. Ultrasound-diagnosed RAO rates were 2.0% and 3.8% at 2- and 30-day follow-ups, respectively. Logistic regression analysis identified that the sheath-to-artery ratio (per 0.1) (odds ratio [OR] 5.71; 95% confidence interval [CI] 1.18–27.71; p = 0.001) was associated with more frequent RAO and that hypertension (OR 0.22; 95% CI 0.06–0.81; p = 0.023) was associated with less frequent RAO. Receiver operating characteristic curve analysis revealed that a sheath-to-artery ratio of 1.47 was the cutoff for 30-day post-procedural RAO (sensitivity 72%, specificity 81%). Sheathless transradial primary PCI for ACS was associated with a low incidence of access-site complications and a higher sheath-to-artery ratio cutoff for RAO than that expected from conventional PCI using sheaths based on historical data, demonstrating the access-site safety of sheathless guiding catheters and their benefit in PCI for ACS (University Hospital Medical Information Network-Clinical Trial Registry Number UMIN000019931).

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We would like to thank Manami Kumagai, Ai Saito, Shizuka Ito, Ayako Ishino, Keisuke Ishida, and Toru Okuzono at Sendai Kousei Hospital and Shigeaki Kato at Tokiwa Foundation for helping with the work and collection of data.


This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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TI: Conceptualization, investigation, writing—original draft, formal analysis. KH: Review and editing, investigation, data curation. MT: Formal analysis. TO: Project administration, supervision.

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Correspondence to Tsuyoshi Isawa.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Isawa, T., Horie, K., Taguri, M. et al. Access-site complications of transradial percutaneous coronary intervention using sheathless guiding catheters for acute coronary syndrome: a prospective cohort study with radial ultrasound follow-up. Cardiovasc Interv and Ther 35, 343–352 (2020).

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