title: Transradial versus transfemoral rotablation for heavily calcified coronary lesions in contemporary drug-eluting stent era.
abstract: 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.
  
  
  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.
authors.affiliation: Division of Cardiology, Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, China ; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, China ; Cardiovascular Research Centre, School of Medicine, National Yang-Ming University, Taipei, Taiwan, China.
authors.forename: Wei-Hsian
authors.initials: WH
authors.lastname: Yin
authors.affiliation: Division of Cardiology, Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, China.
authors.forename: Chin-Kun
authors.initials: CK
authors.lastname: Tseng
authors.affiliation: Division of Cardiology, Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, China.
authors.forename: Tien-Ping
authors.initials: TP
authors.lastname: Tsao
authors.affiliation: Division of Cardiology, Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, China ; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, China.
authors.forename: Hsu-Lung
authors.initials: HL
authors.lastname: Jen
authors.affiliation: Division of Cardiology, Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, China ; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, China.
authors.forename: Wen-Pin
authors.initials: WP
authors.lastname: Huang
authors.affiliation: Division of Cardiology, Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, China.
authors.forename: Chien-Lung
authors.initials: CL
authors.lastname: Huang
authors.affiliation: Division of Cardiology, Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, China.
authors.forename: Jiann-Jong
authors.initials: JJ
authors.lastname: Wang
authors.affiliation: Division of Cardiology, Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, China.
authors.forename: Mason Shing
authors.initials: MS
authors.lastname: Young
keywords: Calcified lesion; Drug-eluting stent; Rotablation; Transfemoral; Transradial