Transradial Sheathless Approach for PCI.

The lumen of the radial artery in many patients is smaller than the outer diameter of a 6F radial sheath frequently leading to procedural pain, trauma to the radial artery and contributing to radial occlusion. Chronically, neointima formation reduces luminal size further, limiting successful re-intervention in some patients. Sheathless guides are 1-2F sizes smaller than corresponding sheaths and so may potentially reduce radial artery trauma. Although not currently recommended for routine use, the 6.5F Asahi EauCath Sheathless guide has a lower profile than a 5F sheath and the same inner lumen as a 6F guide and has been shown to be especially useful for interventional procedures requiring 6F techniques in patients with small radial arteries. Similarly, the 7.5F Asahi EauCath has a lower profile than a 6F sheath and the same inner lumen as a 7F guide and is useful for procedures requiring a large bore guide catheter. Alternatives include the MediKit Works 5F sheathless system and long dilators designed to allow the sheathless introduction of conventional guides. The recently approved 'Flip' dilator is now available outside Japan; however, experience is currently limited.