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JACC Cardiovasc Interv. 2019 Feb 25;12(4):346-358. doi: 10.1016/j.jcin.2018.11.019.

Procedural Outcomes of Percutaneous Coronary Interventions for Chronic Total Occlusions Via the Radial Approach: Insights From an International Chronic Total Occlusion Registry.

Author information

1
Minneapolis Heart Institute and the Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota; University of Szeged, Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, Szeged, Hungary.
2
Henry Ford Hospital, Detroit, Michigan.
3
Columbia University, New York, New York.
4
Massachusetts General Hospital, Boston, Massachusetts.
5
Beth Israel Deaconess Medical Center, Boston, Massachusetts.
6
VA San Diego Healthcare System and University of California, San Diego, La Jolla, California.
7
Baylor Heart and Vascular Hospital, Dallas, Texas.
8
Minneapolis Heart Institute and the Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota.
9
Medical Center of the Rockies, Loveland, Colorado.
10
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
11
VA Central Arkansas Healthcare System, Little Rock, Arkansas.
12
The Heart Hospital Baylor Plano, Plano, Texas.
13
Torrance Memorial Medical Center, Torrance, California.
14
Piedmont Heart Institute, Atlanta, Georgia.
15
VA Minneapolis Healthcare System and University of Minnesota, Minneapolis, Minnesota.
16
Meshalkin Siberian Federal Biomedical Research Center, Ministry of Health of Russian Federation, Novosibirsk, Russian Federation.
17
Korgialeneio-Benakeio Hellenic Red Cross General Hospital of Athens, Athens, Greece.
18
Cleveland Clinic, Cleveland, Ohio.
19
Emory University, Atlanta, Georgia.
20
Tristar Centennial Medical Center, Nashville, Tennessee.
21
VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas.
22
University of Szeged, Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, Szeged, Hungary.
23
Minneapolis Heart Institute and the Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota. Electronic address: esbrilakis@gmail.com.

Abstract

OBJECTIVES:

This study examined the frequency and outcomes of radial access for chronic total occlusion (CTO) percutaneous coronary intervention (PCI).

BACKGROUND:

Radial access improves the safety of PCI, but its role in CTO PCI remains controversial.

METHODS:

We compared the clinical, angiographic, and procedural characteristics of 3,790 CTO interventions performed between 2012 and 2018 via radial-only access (RA) (n = 747) radial-femoral access (RFA) (n = 844) and femoral-only access (n = 2,199) access at 23 centers in the United States, Europe, and Russia.

RESULTS:

Patients' mean age was 65 ± 10 years, and 85% were men. Transradial access (RA and RFA) was used in 42% of CTO interventions and significantly increased over time from 11% in 2012 to 67% in 2018 (p < 0.001). RA patients were younger (age 62 ± 10 years vs. 64 ± 10 years and 65 ± 10 years; p < 0.001), less likely to have undergone prior coronary artery bypass graft surgery (18% vs. 39% and 35%; p < 0.001), and less likely to have undergone prior PCI (60% vs. 63% and 66%; p = 0.005) compared with those who underwent RFA and femoral-only access PCI. RA CTO PCI lesions had lower J-CTO (Multicenter CTO Registry in Japan) (2.1 ± 1.4 vs. 2.6 ± 1.3 and 2.5 ± 1.3; p < 0.001) and PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) complication (2.3 ± 1.9 vs. 3.2 ± 2.0 and 3.2 ± 1.9; p < 0.001) scores. The mean sheath size was significantly smaller in the RA group (6.6 ± 0.7 vs. 7.0 ± 0.6 and 7.3 ± 0.8; p < 0.0001), although it increased with lesion complexity. Antegrade dissection re-entry (20% vs. 33% and 32%; p < 0.001) was less commonly used with RA, whereas use of retrograde techniques was highest with RFA (47%). The overall rates of technical success (89% vs. 88% vs. 86%; p = 0.061), procedural success (86% vs. 85% vs. 85%; p = 0.528), and in-hospital major complication (2.47% vs. 3.40% vs. 2.18%; p = 0.830) were similar in all 3 groups, whereas major bleeding was lower in the RA group (0.55% vs. 1.94% and 0.88%; p = 0.013).

CONCLUSIONS:

Transradial access is increasingly being used for CTO PCI and is associated with similar technical and procedural success and lower major bleeding rates compared with femoral-only access interventions. (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention [PROGRESS CTO]; NCT02061436).

KEYWORDS:

chronic total occlusion; outcomes; percutaneous coronary intervention; radial approach

PMID:
30784639
DOI:
10.1016/j.jcin.2018.11.019

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