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Circ Cardiovasc Interv. 2019 Jun;12(6):e007778. doi: 10.1161/CIRCINTERVENTIONS.118.007778. Epub 2019 Jun 14.

Radial Versus Femoral Access in Chronic Total Occlusion Percutaneous Coronary Intervention.

Author information

Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (M.M., J.J., M.N.B., E.S.B.).
Division of Cardiovascular Medicine, Hennepin Healthcare, Minneapolis, MN (M.M.).
Department of Internal Medicine, Rutgers New Jersey Medical School, Newark (A.K.).
Department of Internal Medicine, Ascension St John Hospital, Detroit, MI (B.A.).
Division of Cardiology, Department of Medicine, University of Arkansas, Little Rock, (M.S.).
Division of Cardiology, Ain Shams University, Cairo, Egypt (M.S.).
University of Missouri Kansas City and Mid America Heart Institute (M.O.).
Division of Cardiology, University of Texas Medical Branch, Galveston (A.E.).
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (Y.S.).
Division of Cardiology, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH (M.H.S.).
Veterans Affairs North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas (S.B.).
Division of Cardiology, Henry Ford Health System, Detroit, MI (K.A.).
Division of Cardiology, McGill University Health Centre, Montreal, QC, Canada (S.R.).


Background Radial access (RA) is increasingly used in chronic total occlusion (CTO) percutaneous coronary intervention with encouraging results. However, there are concerns about its safety and efficacy because of higher complexity and the need for strong guide catheter support. Methods and Results We performed a systematic review and meta-analysis of all studies published through November 2018 reporting the outcomes of RA versus femoral access in CTO percutaneous coronary intervention. Outcomes included major bleeding, access-site complications, in-hospital major adverse events, and technical success. Nine observational studies with 10 590 patients (10 617 lesions) were included in the meta-analysis. CTO lesions attempted using RA had lower Japan-CTO score (2.3±1.2 versus 2.5±1.3; P<0.001). Use of RA was associated with similar technical success (78.7% versus 78.5%; odds ratio, 1.11; 95% CI, 0.94-1.31; P=0.24; I2=23%), lower risk of access-site complications (0.73% versus 1.79%; odds ratio, 0.34; 95% CI, 0.22-0.51; P<0.001; I2=0%) and major bleeding (0.18% versus 0.9%; odds ratio, 0.22; 95% CI, 0.10-0.45; P<0.001; I2=0%), and similar risk of in-hospital adverse events and in-hospital mortality (odds ratio, 0.36; 95% CI, 0.12-1.07; P=0.07; I2=0%) as compared to femoral access. Results were similar when analyzing radial-only versus any femoral access and when excluding the largest study. Conclusions As compared with femoral access, RA is used in CTO percutaneous coronary intervention of less complex lesions and is associated with fewer access-site complications and major bleeding and comparable technical success.


chronic total occlusion; meta-analysis; percutaneous coronary intervention; radial access; risk

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