{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T17:29:43Z","timestamp":1790616583128,"version":"4.1.0"},"reference-count":29,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T00:00:00Z","timestamp":1742860800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Transradial access (TRA) is the preferred approach for percutaneous coronary intervention (PCI), associated with improved patient comfort, lower vascular complications and lower mortality compared to transfemoral access. However, TRA presents challenges such as radial artery spasm (RAS), radial artery occlusion (RAO), and anatomical variability that have driven the development of the sheathless approach.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>This meta\u2010analysis evaluates the efficacy and safety of a dedicated sheathless system strategy versus conventional sheath\u2010based techniques in TRA PCI.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a systematic review and meta\u2010analysis of studies comparing sheathless and sheath\u2010based approaches in TRA PCI, with outcomes including RAS, access site crossover, access\u2010related bleeding, RAO, procedural success, and procedural metrics. Primary analysis was stratified by study design\u2014randomized controlled trials (RCTs) versus observational studies (OBS)\u2014with additional subgroup analysis based on sheath type. Data were pooled using random\u2010effects models, and heterogeneity assessed via the <jats:italic>I<\/jats:italic>\u00b2 statistic.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eight studies (3 RCTs, 5 OBS) comprising 6380 patients were included. The sheathless approach significantly reduced RAS (OR 0.31; 95% CI: 0.10\u22120.97) and access site crossover (OR 0.34; 95% CI: 0.16\u22120.69) compared to the sheath\u2010based approach, particularly in the conventional sheath subgroup. No significant differences were found in access\u2010related bleeding, RAO, procedural success, or procedural metrics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This meta\u2010analysis supports the sheathless system as a safe and effective alternative to sheath\u2010based TRA PCI, reducing RAS, and crossover without increasing RAO or bleeding risk. These advantages may enhance procedural efficiency and patient comfort, especially in small radial arteries and extend its scope to newer applications.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ccd.31512","type":"journal-article","created":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T21:55:02Z","timestamp":1743198902000},"page":"1668-1676","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Dedicated Sheathless System Versus Sheath\u2010Based Approach for Transradial Percutaneous Coronary Intervention: Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","volume":"105","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1010-2567","authenticated-orcid":false,"given":"Mattia","family":"Basile","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Sciences Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy"},{"name":"Cardiology Department La Paz University Hospital Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmine","family":"Salzillo","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emiliano","family":"Bianchini","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy"},{"name":"Department of Cardiology University of Galway Galway Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9043-6462","authenticated-orcid":false,"given":"Francesco","family":"Bianchini","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy"},{"name":"Universit\u00e0 Cattolica del Sacro Cuore Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6362-7618","authenticated-orcid":false,"given":"Alfonso","family":"Jurado\u2010Rom\u00e1n","sequence":"additional","affiliation":[{"name":"Cardiology Department La Paz University Hospital Madrid Spain"},{"name":"Fundaci\u00f3n de Investigaci\u00f3n IDIPAZ Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9971-8463","authenticated-orcid":false,"given":"Achille","family":"Gaspardone","sequence":"additional","affiliation":[{"name":"Division of Cardiology Sant'Eugenio Hospital Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6569-9401","authenticated-orcid":false,"given":"Francesco","family":"Burzotta","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy"},{"name":"Universit\u00e0 Cattolica del Sacro Cuore Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9680-7412","authenticated-orcid":false,"given":"Gregory A.","family":"Sgueglia","sequence":"additional","affiliation":[{"name":"Division of Cardiology Sant'Eugenio Hospital Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,3,25]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy394"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.09.006"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2016.04.014"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.122.061527"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2019.07.043"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.24360"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2021.0522"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-021-01626-4"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-010-9491-z"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00380-021-02005-8"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.4244\/EIJ-D-19-00380"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/8216831"},{"issue":"9","key":"e_1_2_10_15_1","first-page":"316","article-title":"Transradial Intervention In Patients With Non\u2010St Elevation Acute Coronary Syndrome Using One 4.0 Fr Sheath and One Sheathless Guide Catheter via a Single Puncture Site: The 1\u20101\u20101 Strategy","volume":"30","author":"Horie K.","year":"2018","journal-title":"Journal of Invasive Cardiology"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.4244\/EIJ-D-17-00239"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2016.03.016"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.4244\/EIJV7I8A147"},{"key":"e_1_2_10_19_1","first-page":"237","article-title":"Sheathless Guide Catheter Coronary Intervention via Radial Artery: Single\u2010Center Experience With 9658 Procedures","volume":"27","author":"Tada N.","year":"2015","journal-title":"Journal of Invasive Cardiology"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.4244\/AIJ-D-19-00024"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.30947"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics14171897"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(98)70414-3"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.aucc.2022.10.018"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.4244\/EIJV12I10A207"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2010.03.009"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2003.07.016"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00392-008-0658-5"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/5668728"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.25270\/jic\/21.00353"}],"container-title":["Catheterization and Cardiovascular Interventions"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.31512","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,12]],"date-time":"2025-06-12T04:59:01Z","timestamp":1749704341000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccd.31512"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,25]]},"references-count":29,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2025,6]]}},"alternative-id":["10.1002\/ccd.31512"],"URL":"https:\/\/doi.org\/10.1002\/ccd.31512","archive":["Portico"],"relation":{},"ISSN":["1522-1946","1522-726X"],"issn-type":[{"value":"1522-1946","type":"print"},{"value":"1522-726X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,25]]},"assertion":[{"value":"2025-02-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-25","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}