Transradial Percutaneous Coronary Intervention Research Articles

Validation of a Predictive Score for Radial Artery Spasm in Patients Undergoing Elective Transradial Percutaneous Coronary Procedures

BACKGROUND: Radial artery spasm (RAS) is one of the most common complications during transradial coronary procedures and can increase access-site-related adverse events. There is no standard tool to determine patients at high risk of RAS who would benefit from intensive spasm preventive measures. This study aims to validate a RAS risk score in patients undergoing elective transradial coronary procedures. METHODOLOGY: The study population consisted of a prospective cohort of patients who underwent elective transradial coronary angiography and PCI (n=210). A RAS risk score was used to classify patients as high or low risk. Spasm incidence was recorded and the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of the RAS risk score were determined. RESULTS: RAS incidence was 11.43%. A greater number of patients who had RAS were females (p=0.023), weighed less (64.4 ± 9.20 kg, p=0.0353), had lower body mass index (BMI) (19.9 ± 2.33, p=0.0512), were current smokers (p=0.031) and had peripheral artery disease (PAD) (p<001). The RAS risk score had a sensitivity of 87.50%, a specificity of 76.34%, PPV of 32.31%, NPV of 97.93% and accuracy of 77.62% with c-statistic of 0.8685. CONCLUSION: The RAS risk score may be a good tool to identify patients at high risk of RAS during elective transradial coronary procedures in whom more intensive spasm-preventive measures can possibly lead to a significant reduction in the frequency of RAS and potentially reduce access-site-related adverse events. KEYWORDS: Radial artery spasm, radial artery spasm risk score, predictor of radial artery spasm

RADIAL ARTERY OCCLUSION FOLLOWING TRANSRADIAL CORONARY INTERVENTION

Objective: To determine the frequency of radial artery occlusion followingtransradial coronary intervention in acute myocardial infarction patients. Methodology: This cross-sectional study was conducted at cardiologydepartment Liaqat National Hospital Karachi from 22nd October 2016 to 21stApril 2017. Patients with myocardial infarction going for coronary interventionperformed through radial artery were recruited in this study. Radial artery waspalpated and coronary artery intervention was performed through radial arteryafter procedure patient was shifted to recovery, palpate radial artery after 6hrsand then Doppler ultrasonography was performed which shows no flow,impaired flow or normal laminar flow. Results: A total of 180 patients with myocardial infarction going for coronaryintervention performed through radial artery were recruited in this study. About79% of the patients were above 4 years of age. There were 55.56% male.Diabetes and hypertension were the commonest factor followed by smoking.Frequency of radial artery occlusion following transradial coronary interventionin acute myocardial infarction was observed in 18.89% cases. With respect toage stratification, rate of radial artery occlusion was observed in the range of14.3% to 23.7% in different age groups (p=0.734). Rate of radial arteryocclusion was approximate similar in male and female (p=0.96) while rate ofocclusion was significantly higher in obese (BMI >30 kg/m2) as compared to theoverweight and normal cases (p=0.011). Conclusion: The use of transradial PCI is not only beneficial to reduce bleedingbut also for ischemic complications and mortality in high-risk patientsundergoing coronary interventions. Key Words: Transradial coronary angiography, Radial artery occlusion, Acutemyocardial infarction.

Radial Artery Remodeling following Transradial Percutaneous Coronary Intervention in Men and Women: Insights from Serial Ultrahigh Frequency Ultrasonography.

Remodeling of the radial artery (RA) after transradial percutaneous coronary intervention (TRI) is under studied. To examine the impact of TRI on RA diameter and intimal-medial thickness (IMT) in men and women using 55 Mhz ultrahigh frequency duplex ultrasound (UHFDU). We performed UHFDU at 24 h and 90 days after non-emergent TRI in 41 patients (25 men, 16 women). Changes in RA diameter, IMT and RA injury were compared by patient gender. Multivariate linear regression was used to determine the predictors of RA diameter and IMT. Of the 41 patients, mean age was 66 ± 9.8. Baseline RA diameter was larger in men vs. women (3.1 ± 0.40 mm vs. 2.8 mm ± 0.36, p = 0.02), however there were similar reductions in 90-day diameter (-0.57 ± 0.32 mm vs. -0.64 ± 0.40 mm, respectively; p = 0.48). Baseline IMT was also similar in men and women (0.28 ± 0.04 vs. 0.27 ± 0.06 mm; p = 0.37) and there were 0.073 ± 0.11 mm (26%) and 0.05 ± 0.080 mm (19%) increases in IMT noted, respectively (p < 0.0001 vs. baseline, p = 0.48 for men vs. women). Although UHFDU occasionally detected limited access site intimal tears (12%) at 90 days, frank dissections (2.4%), pseudoaneurysms (2.4%) and total occlusions (4.9%) were infrequent. Female gender correlated with smaller RA diameter at follow-up and there were no predictors of IMT. Following TRI, there is a 20% reduction in RA diameter and a 20-25% increase in IMT. Only gender predicted RA diameter. As a simple, noninvasive method to accurately depict the RA healing response following TRI, UHFDU may inform future clinical investigation in this area.

Evaluation of Bleeding Risk in Patients with Acute Myocardial Infarction Undergoing Transradial Percutaneous Coronary Intervention.

We investigated the accuracy of various bleeding risk scores to estimate the bleeding risk in patients with acute myocardial infarction (AMI) managed with percutaneous coronary intervention (PCI) access via the radial artery.We retrospectively enrolled 1,651 patients who were definitively diagnosed with ST-elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI). We assessed the predictive validities of 30-day bleeding events in various scoring systems using receiver operating characteristic curves.Overall, ACUITY-HORIZONS exhibited the highest area under the curve to predict 30-day bleeding, followed by ACTION and CRUSADE; HAS-BLED displayed the lowest score. With a cut-off of 17, ACUITY-HORIZONS demonstrated the best discrimination for the Thrombolysis in Myocardial Infarction (TIMI) 30-day serious bleeding rate. We observed significant differences among all-cause death, cardiovascular death, and major adverse cardiac events between the ACUITY-HORIZONS groups with a score of ≤ 17 and > 17. ACUITY-HORIZONS score > 17, initial systolic blood pressure (SBP) < 90 mmHg, and Killip III and IV upon admission positively predicted the 30-day bleeding risk, whereas myocardial infarction (MI) and TIMI major bleeding within 30 days, heart failure at admission, and initial SBP < 90 mmHg positively predicted the 30-day mortality.Comparatively, ACUITY-HORIZON is the most reliable system in predicting 30-day bleeding for patients with AMI via transradial PCI. In the transradial scenario, bleeding and MI within 30 days are substantially related to 30-day mortality.

TCTAP A-062 Immediate & Midterm Outcomes Following Transradial PCI with Bioresorbable Vascular Scaffold in Diabetic Patients: Single Centre Single Operator Experience in Bangladesh

Bioresorbable Vascular Scaffolds (BVS) were developed in order to reduce the late clinical consequences that were hypothesized to be caused by the effects of metal and polymers of DES on the vessel wall, including inflammation and neoatherosclerosis, particularly seen in diabetic subjects. We sought

TCTAP C-136 Unexpected Complications During Transradial PCI

### Patient Initials or Identifier Number X ### Relevant Clinical History and Physical Exam A 55 years old hypertensive, Diabetic, Smoker, middle age gentleman came with recurrent Chest Pain for last 2 months. patient developed persistent chest pain for 2 hours diagnosed as a case of UA. on

Abstract 16927: Validation of CathPCI Bleeding Model in Transradial vs. Transfemoral PCI Patients

Background: Estimation of bleeding risk in patients undergoing PCI informs the use of bleeding avoidance strategies, allows for personalized consent, and supports quality improvement efforts. The CathPCI Bleeding Model (CPBM) was developed in patients undergoing PCI between 2008 and 2011, when PCI was performed predominantly via transfemoral (TF) access. Whether this model functions equally well in transradial (TR) PCI is unclear. Objectives: This study sought to determine if the CPBM behaves differently for PCI performed via TF vs TR access. Methods: Patients who underwent PCI between Q4 2010 and Q4 2016 were identified from an institutional CathPCI Registry. The primary outcome was post-PCI bleeding within 72 hours or before hospital discharge. A logistic regression model was created predicting CPBM on the 10-variable reduced model. Interactions between each variable and access site were tested. Using the CPBM integer scoring system, the interaction between low, moderate, and high risk groups with the access site was tested. Results: TR access increased from 14% in 2010 to 60% in 2016. Major bleeding was lower for TR than TF PCI (2.5% vs 7.3%, p &lt; 0.001). Prior PCI was protective of bleeding in the TF, but predictive of bleeding in the TR group. There was no significant interaction between access site and all remaining variables (Fig. 1). There was no difference in the discriminative capacity of the CPBM between TR and TF access (Fig. 1). The CPBM integer score behaved similarly between groups, without significant interaction, p = 0.53 (Fig. 2). Conclusions: The CPBM may be used to estimate patients’ bleeding risk regardless of PCI access site.

Transradial left main PCI is safe and effective.

Transradial left main PCI is safe and effective.

Efficacy and safety of a 260-cm Amplatz Super Stiff guidewire during transradial percutaneous coronary intervention

BackgroundAlthough transradial percutaneous coronary intervention (TR-PCI) is widely used in clinical practice, guidewire-related complications are an important cause of transradial approach failure. We investigated the prognostic value of the 260-cm Amplatz Super Stiff guidewire for reducing the complication rate during TR-PCI.MethodsFive hundred patients with positive Allen's test results were divided into 3 groups according to the type of angiography guidewire: group A, 150-cm Emerald guidewire standard J-tip (n = 160); group B, 150-cm Radifocus guidewire M (n = 176); and group C, exchangeable 260-cm Amplatz Super Stiff guidewire after placement of a 150-cm Radifocus guidewire M (n = 164).ResultsGroup C had the highest success rate (P = .008) and the lowest incidence of operative complications such as radial artery spasms and hematomas (P = .030 and P = .036, respectively). In addition, the groups differed significantly in terms of fluoroscopy and catheter placement times (P = .02. and P < .001, respectively); group C had the shortest times for these occurrences.ConclusionsThe exchangeable 260-cm Amplatz Super Stiff guidewire markedly decreased the incidence of guidewire-related complications, reduced fluoroscopy times, and increased the procedural success rate. Therefore, this tool can be considered a safe, effective, and feasible exchangeable guidewire for TR-PCI.

The effect of radial artery hemostat continuous compression time in patients undergoing transradial percutaneous coronary intervention

Objective To investigate the effect of radial artery hemostat (TR Band) continuous compression time on bleeding of puncture point, thumb perception, palm swelling and subjective comfort in patients undergoing transradial percutaneous coronary intervention. Methods One hundred and fifty-five patients who underwent transradial percutaneous coronary intervention were randomly divided into two observation groups and a control group. All patients in the three groups were treated by TR Band patent hemostasis. All three groups received the consistent deflation schedule, except the TR Band was removed at the 12th hour post operation in the control group, and at the 6th hour in the 1st observation group and at the 4th hour in the 2nd observation group. Postoperative bleeding of puncture point, thumb perception, palm swelling and subjective comfort were observed in the three groups. Results The differences of postoperative bleeding of puncture point, thumb perception, palm swelling and subjective comfort among the three groups were statistically significant (χ2=6.31, P<0.05; F=5.26, 4.00, 14.69, P<0.01). In the 2nd observation group, palm swelling was the lowest, but perception, and comfort and bleeding rate is the highest among the three groups. In the 1st observation group, the overall indexes were medium among the three groups. Conclusions The optimal compression duration of TR Band post transradial percutaneous coronary intervention is 6 h, which does not increase the risk of bleeding, but also significantly improve local swelling and perceptual experience, and increase patient comfort. Key words: Radial artery hemostat; Coronary artery interventional therapy

TCT-751 Effect of Pigtail Assisted Tracking (PAT) of Guide Catheter During Transradial Coronary Angioplasty on Forearm Complications: A Prospective Randomized Trial

In transradial percutaneous intervention (PCI), the sharp edge of guide catheter tip may produce “Razor blade effect” leading to radial vascular injury. Recently, Pigtail Assisted Tracking (PAT) technique has been described to overcome it. Present study was done to prospectively evaluate the PAT

TCT-804 Comparative Validation of the ALPHA Score, a Novel Risk Model Including Vascular Access Site for Predicting 30-Day Mortality in Patients Treated With Primary PCI

Transradial primary PCI has been shown to cut mortality risk and is gaining popularity worldwide. To reflect this change in practice, a new risk model including access site has been developed for predicting 30-day mortality. Though the ALPHA (Age, Life support, Pressure, Heart rate, Access site; <

Angiographic Analysis of Trans-Radial Percutaneous Coronary Intervention Cases by the Backup Support of Guide Extension Catheter

Background:The guide extension catheter – Guidezilla (Boston Scientific, United States of America) is a useful adjunctive tool in percutaneous revascularization of complex coronary lesions, and provides an extension to the guide catheter with better coaxial alignment, support and stability.Objective: The objective of this study was to describe the usefulness and easy deliverability of stent by Guidezillain the trans-radial treatment of complex coronary lesions as our initial experience.Methods:This prospective observational study was conducted at the Department of Cardiology, Ibrahim Cardiac Hospital &amp; Research Institute (ICHRI), Dhaka from July 2016 to September 2017. The transradial approach was used in all cases. Clinical, angiographic and procedural data of percutaneous coronary interventions performed using Guidezilla, including indications for use of Guidezilla were collected and analyzed.Results:A total of 19 procedures (in 18 patients) were evaluated. 57.89% of cases were related to left circumflex coronary artery or obtuse marginal branch. The commonest challenge for use of Guidezillawas proximal angulation (63.15%) and calcification (47.4%). Commonest type of lesion was ACC/ AHA Type C lesion (63.2%). Successful stent deployment was achieved in 16 of the 19 procedures (84.2%). Among the unsuccessful cases, there was stent damage in one case and distal dissection after deployment of a stent in other. Stent deployment was not possible in two cases, due to diffuse lesion and heavy calcification.Conclusions:Guide extension catheter is a good trans-radial back-up support for calcified, complex and tortuous coronary anatomy, which otherwise may have been considered unsuitable for PCI. The use of such support can reduce the necessity for the more expensive alternative of deploying multiple small stents in order to traverse the lesions.Bangladesh Heart Journal 2018; 33(1) : 54-60

From debulking to delivery: sequential use of rotational atherectomy and Guidezilla\u2122 for complex saphenous vein grafts intervention

BackgroundPercutaneous coronary interventions (PCI) of old calcified saphenous vein grafts (SVGs) is challenging and is associated with a considerably high risk of adverse ischemic events in the short- and long-term as compared to native coronary arteries. We report a case in which a non-dilatable, calcified SVG lesion is successfully treated with rotational atherectomy followed by PCI and stenting with local stent delivery (LSD) technique using the Guidezilla™ guide extension catheter (5-in-6 Fr) in the “child-in-mother” fashion.Case presentationA 70 years-old man with a dilated ischemic cardiomyopathy, triple coronary artery bypass grafting (CABG) in 1990 and chronic renal failure (baseline GFR: 45 ml/min/1.73 m2) underwent a coronary angiography for a Non-ST segment elevation myocardial infarction (NSTEMI). Native coronary circulation was completely occluded at the proximal segments. Grafts angiography showed a tandem calcified lesions of SVG on distal right coronary artery (RCA) and an ostial stenosis of the SVG on first obtuse marginal branch (OM1). Left internal mammary artery on the mid left anterior descending artery was patent. Ad Hoc PCI of SVG on RCA was attempted. The proximal calcified stenosis has been crossed with a 1.5 x 12 mm balloon only with the support of Guidezilla™, however the non-compliant (NC) balloon 2.5 x 15 mm was unable to break the hard and calcified plaque. After several attempts, the procedure was interrupted with a suboptimal result. An elective transradial PCI of SVG on RCA with rotational atherectomy was performed. Two runs with 1.25 mm burr and 2 runs with 1.5 mm burr were carried out. Then, the use of distal anchoring balloon warranted support and tracking, made as centring rail for the advance of the tip of the “mother-and-child” catheter into the SVG. During slow deflation of the balloon, the Guidezilla™ was advanced distal to the stenoses to be stented, thus allowing the placement of two long drug eluting stents according to a LSD technique.ConclusionsRotational atherectomy is a feasible option for non-dilatable stenoses in old SVGs when there is no evidence of thrombus or vessel dissection and the subsequent use of “mother-and-child” catheter has a key role, especially in case of radial approach, for long stents delivery.

Trans Radial Percutaneous Coronary Intervention in Very Elderly Patients (Age 80 years or above) with Acute Coronary Syndrome: Immediate and Short term Outcome, Single Centre Experience.

Trans Radial Percutaneous Coronary Intervention in Very Elderly Patients (Age 80 years or above) with Acute Coronary Syndrome: Immediate and Short term Outcome, Single Centre Experience.

Discharging a Patient After a Percutaneous Coronary Intervention

Q Are there evidence-based guidelines or best practices related to same-day discharge of a patient who had a percutaneous coronary intervention?A Cynthia Webner, DNP, CCNS, ACNPC-AG, CCRN-CMC, CHFN, replies:Since Dr Andreas Grüntzig1 and his colleagues in 1979 published the result of their experience with the first 50 patients to undergo percutaneous transluminal coronary angioplasty in Zurich, Switzerland, technology has advanced. The incidence of percutaneous coronary interventions (PCIs) outdistances the number of patients undergoing coronary artery bypass grafting by 3 to 1.2,3 The volume of inpatient PCI procedures reaches nearly 1 million annually in the United States2 and the number of hospitals in the United States providing PCI continues to increase.3,4 Advancements in technology, operator skill, increased procedural success, and improved safety, including low postprocedural complication rates, contribute to more patients being considered for same-day discharge after an uncomplicated elective PCI. There are reports of same-day PCI discharges since the late 1990s. However, many patients continue to stay overnight following elective procedures.5 Fiscal responsibility encourages a same-day discharge strategy resulting in substantial cost savings.5,6 Resistance to same-day discharge remains because of concern for patient safety.The most recent PCI guidelines from the American College of Cardiology do not address same-day discharge after PCI.7 However, the Society for Cardiovascular Angiography and Interventions (SCAI), with support from the American College of Cardiology, published a consensus document in 2009 outlining the clinical decision-making process regarding the length of stay for the PCI patient. Postprocedural complications, including abrupt vessel closure, access-site complications, and management of comorbid conditions, are some of the top concerns for patient safety. Regarding same-day discharge, the SCAI recommends the facility consider locating this population in 1 unit with a consistent staff who are proficient in procedure follow-up, expected complications, and treatment of those complications. The staff should also be proficient in providing patient education, which should include recognition of and response to procedural complications, an understanding of the importance of dual antiplatelet agents, risk factor modification strategies, and physician follow-up. Assessment of outcome data is essential with the development of a same-day PCI discharge program.8On the basis of multiple clinical studies assessing outcomes related to same-day discharge, the SCAI provides a classification scheme for the management of patients after PCI. This classification system can provide direction when considering same-day discharge. The classification scheme considers high-risk patient features, including advanced age, decreased renal function, reduced left ventricular ejection fraction, female sex, diabetes mellitus, and more complex coronary lesions. The scheme identifies 6 categories of criteria to assist in the decision to include or exclude patients from the same-day discharge plan: (1) clinical criteria, (2) comorbidity considerations, (3) anatomic coronary complexity, (4) procedural complexity, (5) complications, and (6) other criteria, with consideration for social aspects.8Since the publication of these criteria, further research has demonstrated good outcomes with same-day discharge in patients with both femoral and radial access.5,9–11 Jabara and colleagues12 evaluated 450 patients who had undergone transradial PCI and demonstrated that all complications occurred either within 0 to 6 hours of the procedure or more than 24 hours after the procedure. Subherwal and colleagues9 evaluated more than 1 million patients who underwent PCI from 2005 through 2009 to determine complication rates including bleeding. During this time there was a nearly 20% reduction in post-PCI bleeding. Elective PCI had the lowest rate of bleeding, decreasing from 1.4% to 1.1%. Non–ST-segment elevation myocardial infarction bleeding rates also dropped from 2.3% to 1.8%, with no significant change noted in patients with ST-segment elevation myocardial infarction. One of the likely reasons for decreased access-site bleeding rates in patients undergoing PCI as reported by this study is the noticeable change in antithrombotic strategy, with an increased procedural use of bivalirudin alone (from 17% to 30%) and a decreased procedural use of heparin and bivalirudin in combination (from 41% to 28%).9On the basis of studies published through 2015, Shroff and colleagues13 recommend liberalization of some of the criteria put forth by the SCAI for same-day PCI discharge. The authors cite increased patient satisfaction, increased bed availability, and substantial cost savings as benefits to same-day discharge.13 As same-day post-PCI discharges increase, clinical experts agree that a successful same-day discharge strategy should consider the patient, the procedure, and the program.13,14 Formal programs that consider patient-related factors such as social support, the ability to comply with recommendations (including reporting of adverse events), understanding of dual antiplatelet therapy, and the willingness and ability to comply with follow-up should be established. Current evidence suggests that same-day PCI discharge can be safe and beneficial for the patient and organization in select patients. However, formal structures and processes of care should be well established for a same-day PCI discharge program to be successful.15

Association Between Maximal Activated Clotting Time and Major Bleeding Complications During Transradial and Transfemoral Percutaneous Coronary Intervention

ObjectivesThis study sought to determine whether higher maximal activated clotting time (ACT) during transradial (TR) percutaneous coronary intervention (PCI) is associated with greater bleeding risk. BackgroundHigher maximal ACT during transfemoral (TF) PCI has been associated with a greater bleeding risk. It is unclear whether this relationship exists in the setting of TR PCI. MethodsAmong 14,637 patients undergoing TR or TF PCI with unfractionated heparin monotherapy, the study related maximal ACT to the risk of major bleeding. In secondary analyses, the study related maximal ACT to composites of in-hospital death, myocardial infarction (MI), or stroke and in-hospital death, MI, or urgent target vessel revascularization. Multivariable logistic regression was employed to compare outcomes in the third with the first and second maximal ACT tertiles. ResultsMore major bleeding occurred at ACT >290 s versus ≤290 s following TF (7.7% vs. 5.8%; p = 0.006) but not TR PCI (1.7% vs. 2.4%; p = 0.18). After adjustment, major bleeding risk remained significantly higher at ACT >290 s versus ACT ≤290 s among TF (odds ratio: 1.28; 95% confidence interval: 1.02 to 1.62; p = 0.036) but not TR PCI (odds ratio: 0.72; 95% confidence interval: 0.42 to 1.22; p = 0.22). Maximal ACT was not related to the incidence of composite death, MI, or stroke or death, MI, or urgent target vessel revascularization following TF or TR PCI. ConclusionsHigher maximal ACT is associated with a greater risk of major bleeding following TF PCI than TR PCI.

Percutaneous Endovascular Repair of a Radial Artery Pseudoaneurysm Using a Covered Stent

A 65-year-old man with a history of hypertension and atrial fibrillation on oral anticoagulant agents underwent transradial percutaneous coronary intervention for an acute coronary syndrome. A week after the procedure, the patient presented with a progressively enlarging pulsatile mass at the radial

Implementation of a clinical nursing pathway for percutaneous coronary intervention: A prospective study

This study is to evaluate the effect of a clinical nursing pathway (CNP) on the clinical outcomes of the transradial approach for emergency percutaneous coronary intervention (PCI). A total of 118 subjects diagnosed with acute myocardial infarction (AMI) were enrolled in the study. They were randomly divided into a control group receiving conventional nursing and a clinical nursing pathway group. The differences in door-to-balloon time, length of hospital stay, hospitalization cost, postoperative complications, and patient satisfaction with nursing care between the two groups were determined and analyzed statistically. Results indicated that the clinical nursing pathway is a more cost-effective care strategy for transradial PCI in the setting of AMI resulting in a reduced door-to-balloon time, less post-operative complications, and improved patient satisfaction.

Transradial percutaneous coronary intervention for left main bifurcation lesions using 7.5-Fr sheathless guide catheter.

Recent studies have shown sheathless guide catheters (GCs) to be safe and effective during complex lesions such as bifurcations, chronic total occlusion (CTO), and/or calcified lesions. We investigated the feasibility and safety of using 7.5-Fr sheathless GC for transradial percutaneous coronary intervention (PCI) to treat left main bifurcation lesions.A total of 82 patients were consecutively enrolled from March 2013 to February 2016. They underwent transradial PCI for left main bifurcation lesions using the 7.5-Fr sheathless GC.The mean syntax score was 28.1 ± 6.1, and the majority (n = 55, 67.1%) was intermediate scores (23∼32). The unprotected LM disease was present in 67 of 82 patients (81.7%), and true bifurcation (Medina 1, 1, 1) was present in 46 of 82 patients (56.1%). The 2-stent technique was used in 62 of 82 patients (75.6%). The 2-stent technique included 31 cases (37.8%) of “Crush,” 18 cases (22.0%) of “Cullote,” and 13 (15.8%) cases of “T stent and modified T stent” (T stent). Immediate angiographic success rate was 100% (82/82), and procedural success rate was 97.6% (80/82). The vascular complications occurred in 3 patients (3/82, 3.7%).The use of 7.5-Fr sheathless GC is safe and allows PCI for complex bifurcation lesions located in the distal of left main to be performed transradially with a high success rate.