Transradial versus transfemoral rotablation for heavily calcified coronary lesions in contemporary drug-eluting stent era

Background Although radial access for drug-eluting stent(DES) combined with rotational atherectomy(RA) in patients with calcified coronary lesions may be associated with a lower risk of major bleeding complications and obtain favorable clinical results compared with femoral access,the long-term outcome data of this approach were limited in contemporary DES era.Methods & Results This retrospective study sought to compare in-hospital and long-term outcomes for patients undergoing RA via the transradial(TR) and transfemoral(TF) route in 126 consecutive patients(59 radial,67 femoral) from 2009 to 2014.TR RA procedures were performed in 44/62(71%) by the three TR operators,compared with 15/64(23%) by the four TF operators in the present study.Significantly smaller diameter guide catheters and burrs(1.39 ± 0.16 mm vs.1.53 ± 0.24 mm,P = 0.001) were used in the TR group.Procedural success rates were similar in both TR and TF groups.There was a significantly less major access site bleeding complications in favor of radial artery access(2%vs.16%,P = 0.012).The incidence of in-hospital death or myocardial infarction was low in both groups.Although a trend of lower adverse event rate was demonstrated in the TR group compared with the TF one,no statistical significance(21%vs.27%,P = 0.135) was detected.Conclusions Radial access,a useful alternative to femoral access for RA and DES,can be safely and successfully performed on up to 71%of the patients with heavily calcified coronary lesions needing RA by experienced TR operators.