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Full transradial approach feasible in CTO PCI
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A fully transradial approach for patients undergoing PCI for chronic total occlusion is a safe and effective alternative to a transfemoral approach and showed a high success rate as well as low complication rates, according to data published in Circulation: Cardiovascular Interventions.
The researchers used the RECHARGE registry, a large, prospective, multicenter cohort of CTO PCI procedures, to compare a fully transradial approach with a transfemoral approach on technical success, procedural characteristics and complications.
“Chronic total occlusion percutaneous coronary intervention still represents the most challenging settings for percutaneous coronary intervention, with recent optimal procedural success obtained thanks to advance in tools and techniques,” Erik Jan Bakker, MD, PhD, from the department of cardiology at St. Antonius Hospital Nieuwegein in the Netherlands, and colleagues wrote. “Transfemoral access is still the preferred one, especially for those cases requiring possible need for multiple technical approaches and complex techniques, with documented lower procedural success rates with higher chronic total occlusion lesion complexity.”
The study included 1,253 CTO PCI procedures among 1,177 patients in 17 centers from Belgium, France, the Netherlands and the United Kingdom between January 2014 and October 2015.
Twenty-four percent of patients received a fully transradial approach, and a transfemoral approach was applied in 76% of cases.
Researchers found a median Japanese CTO score of 2.1 ± 1.2 in the fully transradial approach and 2.3 ± 1.1 in the transfemoral approach (P = .06).
The rate of technical success was 85% in the fully transradial approach group and 86% in the transfemoral approach group (P = .51), and was similar in different Japanese CTO score subgroups after multivariable analysis and after propensity adjustment.
In-hospital major adverse cardiac and cerebral events occurred in 2% in the fully transradial group and 2.9% in the transfemoral group (P = .4), according to the researchers. Major access site bleeding was observed in 0.3% of the fully transradial group and 0.5% of the transfemoral group (P = .66).
In the fully transradial approach, results showed similar procedural duration times (80 minutes vs. 90 minutes; P = .07) vs. the transfemoral approach, as well as similar radiation dose (dose area product, 89 Gy × cm2 vs. 101 Gy × cm2; P = .06) and lower contrast agent use (200 mL vs. 250 mL; P < .01).
“The use of a fully transradial approach in the settings of chronic total occlusion percutaneous coronary intervention should be considered a valid alternative to the conventional transfemoral approach not only in relatively easy chronic total occlusion lesions, but also in more complex settings,” Bakker and colleagues wrote. “Thanks to the advances in dedicated tools and techniques, procedural success with fully transradial approach can potentially reach comparable rates to transfemoral approach, especially when performed in expert hands.” – by Dave Quaile
Disclosures: The study was funded by a grant from Boston Scientific. Bakker reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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