TY - JOUR
T1 - Femoral or Radial Approach in Treatment of Coronary Chronic Total Occlusion
T2 - A Randomized Clinical Trial
AU - Gorgulu, Sevket
AU - Kalay, Nihat
AU - Norgaz, Tugrul
AU - Kocas, Cuneyt
AU - Goktekin, Omer
AU - Brilakis, Emmanouil S.
N1 - Publisher Copyright:
© 2022 American College of Cardiology Foundation
PY - 2022/4/25
Y1 - 2022/4/25
N2 - Objectives: The aim of this study was to compare transradial access (TRA) with transfemoral access (TFA) for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Background: TRA reduces the risk for vascular access complications but may make complex PCI, such as CTO PCI, more challenging. Methods: FORT CTO (Femoral or Radial Approach in the Treatment of Coronary Chronic Total Occlusion) (NCT03265769) was a prospective, noninferiority, randomized controlled study of TRA vs TFA for CTO PCI. The primary study endpoint was procedural success, defined as technical success without any in-hospital major adverse cardiovascular events. The secondary study endpoint was major access-site complications. Results: Between 2017 and 2021, 610 of 800 patients referred for CTO PCI at 4 centers were randomized to TRA (n = 305) or TFA (n = 305). Mean J-CTO (Multicenter CTO Registry in Japan) (2.1 ± 0.1 vs 2.2 ± 0.1; P = 0.279), PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) (1.3 ± 0.9 vs 1.1 ± 1.0; P = 0.058) and PROGRESS CTO complication (2.4 ± 1.8 vs 2.3 ± 1.8; P = 0.561) scores and use of the retrograde approach (11% vs 14%; P = 0.342) were similar in the TRA and TFA groups. TRA was noninferior to TFA for procedural success (84% vs 86%; P = 0.563) but had fewer access-site complications (2.0% vs 5.6%; P = 0.019). There was no difference between TFA and TRA in procedural duration, contrast volume, or radiation dose. COnclusions: TRA was noninferior to TFA for CTO PCI but had fewer access-site complications.
AB - Objectives: The aim of this study was to compare transradial access (TRA) with transfemoral access (TFA) for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Background: TRA reduces the risk for vascular access complications but may make complex PCI, such as CTO PCI, more challenging. Methods: FORT CTO (Femoral or Radial Approach in the Treatment of Coronary Chronic Total Occlusion) (NCT03265769) was a prospective, noninferiority, randomized controlled study of TRA vs TFA for CTO PCI. The primary study endpoint was procedural success, defined as technical success without any in-hospital major adverse cardiovascular events. The secondary study endpoint was major access-site complications. Results: Between 2017 and 2021, 610 of 800 patients referred for CTO PCI at 4 centers were randomized to TRA (n = 305) or TFA (n = 305). Mean J-CTO (Multicenter CTO Registry in Japan) (2.1 ± 0.1 vs 2.2 ± 0.1; P = 0.279), PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) (1.3 ± 0.9 vs 1.1 ± 1.0; P = 0.058) and PROGRESS CTO complication (2.4 ± 1.8 vs 2.3 ± 1.8; P = 0.561) scores and use of the retrograde approach (11% vs 14%; P = 0.342) were similar in the TRA and TFA groups. TRA was noninferior to TFA for procedural success (84% vs 86%; P = 0.563) but had fewer access-site complications (2.0% vs 5.6%; P = 0.019). There was no difference between TFA and TRA in procedural duration, contrast volume, or radiation dose. COnclusions: TRA was noninferior to TFA for CTO PCI but had fewer access-site complications.
KW - coronary chronic total occlusion
KW - percutaneous coronary intervention
KW - transfemoral access
KW - transradial access
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U2 - 10.1016/j.jcin.2022.02.012
DO - 10.1016/j.jcin.2022.02.012
M3 - Article
C2 - 35450683
AN - SCOPUS:85127699962
SN - 1936-8798
VL - 15
SP - 823
EP - 830
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 8
ER -