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

Peter Tajti, Khaldoon Alaswad, Dimitri Karmpaliotis, Farouc A. Jaffer, Robert W. Yeh, Mitul Patel, Ehtisham Mahmud, James W. Choi, M. Nicholas Burke, Anthony H. Doing, Phil Dattilo, Catalin Toma, A. J.Conrad Smith, Barry F. Uretsky, Elizabeth Holper, Srinivasa Potluri, R. Michael Wyman, David E. Kandzari, Santiago Garcia, Oleg KrestyaninovDmitrii Khelimskii, Michalis Koutouzis, Ioannis Tsiafoutis, Jaikirshan J. Khatri, Wissam Jaber, Habib Samady, Brian Jefferson, Taral Patel, Shuaib M Abdullah, Jeffrey W. Moses, Nicholas J. Lembo, Manish Parikh, Ajay J. Kirtane, Ziad A. Ali, Darshan Doshi, Iosif Xenogiannis, Larissa I. Stanberry, Bavana Venkata Rangan, Imre Ungi, Subhash Banerjee, Emmanouil S Brilakis

Research output: Contribution to journalArticle

3 Scopus citations

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)

Original languageEnglish (US)
Pages (from-to)346-358
Number of pages13
JournalJACC: Cardiovascular Interventions
Volume12
Issue number4
DOIs
StatePublished - Feb 25 2019

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Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Tajti, P., Alaswad, K., Karmpaliotis, D., Jaffer, F. A., Yeh, R. W., Patel, M., Mahmud, E., Choi, J. W., Burke, M. N., Doing, A. H., Dattilo, P., Toma, C., Smith, A. J. C., Uretsky, B. F., Holper, E., Potluri, S., Wyman, R. M., Kandzari, D. E., Garcia, S., ... Brilakis, E. S. (2019). Procedural Outcomes of Percutaneous Coronary Interventions for Chronic Total Occlusions Via the Radial Approach: Insights From an International Chronic Total Occlusion Registry. JACC: Cardiovascular Interventions, 12(4), 346-358. https://doi.org/10.1016/j.jcin.2018.11.019