Evaluation of Railway Sheathless Access System for Transradial Coronary and Peripheral Interventions.

OBJECTIVE: Evaluate efficacy and safety of Railway Sheathless Access System™ (Railway) in the first 200 consecutive cases at our center. BACKGROUND: Transradial Intervention (TRI) is limited by the frequent occurrence of spasm, radial artery occlusion (RAO) and inability to use larger guide catheters (GC). The small size of radial artery (RA) is the primary reason for these limitations. Railway allows downsizing by sheathless GC access with GC of any shape or brand. METHODS: Procedural and clinical variables were recorded prospectively for every case with intended use of Railway in the medical records. Hospital wide documentation of arm pain, radial spasm and pre-discharge evaluation of RAO with reverse Barbeau's test was performed by nurses. We retrospectively reviewed the data of the first consecutive 200 cases with the intended use of the Railway. RESULTS: Railway was used successfully to complete intended procedure in 199 (99.5%) of the 200 patients. Railway was used with a 6 Fr (171) or 7 Fr (29) GC of various shapes to achieve sheathless access in 197 patients and for tracking the GC through severe RA tortuosity or mitral paravalvular leak in the rest. Three patients (1.5%) had spasm and forearm pain, two (1%) patients had small (<5 cm) hematoma, while one (0.5%) patient required access switch over and subsequently had RAO. CONCLUSION: Railway Sheathless Access System can be used routinely for TRI with high success rate and low complication rate.