Percutaneous coronary intervention via transulnar sheathless approach

Diagnostic and interventional coronary procedures via cannulation of the radial artery have proven to be useful in patients with acute coronary syndrome (ACS) ST-segment elevation myocardial infarction, non-ST-segment elevation ACS, and non-ACS clinical syndromes.^1,2 In many patients, vascular access and catheter advancement can be difficult due to vessel size, vasospasm, anatomical branching variations, and catheter manipulation. The ulnar artery may prove to be a preferred alternative in many cases where the radial artery is unable to be utilized.³ Furthermore, the use of large caliber catheters through these smaller caliber vessels also limits the use of some devices for treatment of bifurcation lesions. We report the use of a sheathless percutaneous coronary intervention through the ulnar artery. In this case a sheathless technique was shown. The sheathless catheter has already been shown as safe in small case series and in a multicenter registry.^4-6 With a smaller luminal diameter than that of traditional sheath systems, the risk of vasospasm, vascular damage, radial artery occlusion, and bleeding complications, even in maximal platelet inhibition, is theoretically reduced.⁷.