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Transradial PCI for complex CTO may pose technical challenges
The success rate of transradial PCI was comparable to that of transfemoral PCI for treatment of noncomplex chronic total occlusions, but the transradial PCI success rate was significantly lower when treating more complex cases, according to new study results.
Researchers enrolled consecutive patients who were not receiving hemodialysis and had undergone PCI for CTO from 2005 to 2014. Procedural difficulty for each lesion was graded using the Multicenter CTO Registry of Japan (J-CTO) score based on lesion characteristics and prior attempts to open the CTO. Patients were categorized according to whether transradial or transfemoral access was used for PCI. Access site and guiding size used for the antegrade approach was used to categorize cases of hybrid access.
Transradial and transfemoral access was used in 280 and 305 CTO PCI procedures, respectively. In the entire cohort, technical success rates were not different for the two approaches (74.6% vs. 72.5%; P = .51). Similarly, success rates were also comparable in the propensity score-matched analysis (70.6% vs. 73.3%; P = .57), the researchers wrote.
However, when the researchers analyzed only patients with J-CTO scores of at least 3, the success rate was lower in the transradial group compared with the transfemoral group (35.7% vs. 58.2%; P = .04).
In multivariate analysis, predictors of CTO PCI failure with transradial access included use of guiding catheter size < 7F (OR = 5.5; P = .008), moderate or severe calcification (OR = 3.2; P = .001), occlusion length > 20 mm (OR = 2.97; P < .001) and age (OR = 1.04; P = .03), according to the data.
“In transradial CTO PCI, if possible, a guiding catheter size of 7F should be selected regardless of lesion morphology. Moreover, the transfemoral approach should be preferentially considered for complex CTO, particularly in cases with moderate or severe calcification,” the researchers wrote. “Our results may help identify suitable candidates for the treatment of CTO via the transradial approach.” – by Melissa Foster
Disclosure: The researchers report no relevant financial disclosures.