Advantages of Transradial Rotational Atherectomy versus Transfemoral Approach in Elderly Patients with Hard-Handling Calcified Coronary Lesions - A Single Center Experience.

Background: Balloons cannot pass through severely calcified coronary lesion (SCCL), and sometimes they cannot be opened at a high pressure even if they can pass through the lesion. There are limited data on rotational atherectomy (RA) via transradial access (TRA) in this setting. The aim of this study was to evaluate in-hospital and 1-year outcomes in elderly patients with SCCL who underwent RA via TRA.

Methods: Eighty-six consecutive elderly patients with de novo SCCL who underwent RA were enrolled and divided into TRA (n = 45) and transfemoral access (TFA, n = 41) groups in this retrospective analysis from 2008 to 2013. Baseline characteristics and in-hospital and 1-year endpoints were compared between both groups.

Results: Compared to TFA, 6Fr guide catheters were used significantly more in the radial approach (p < 0.001). In the TRA group, the rate of burr size (1.25 mm) was higher and the mean burr size was smaller (p = 0.021) than that in the TFA group. Vascular access site complications, bed rest time and hospital stay were significantly lower in the TRA group compared with the TFA group (p = 0.029, < 0.001, < 0.001, respectively). However, there was no significant difference in major adverse cardiac events during hospitalization and after 1 year follow-up between both groups (p = 0.338, 1.000, respectively).

Conclusions: TRA is a useful alternative to TFA in elderly patient with SCCL. The advantages of TRA over TFA include reduced time of bed rest and hospital stay and vascular complications at the puncture site.