OBJECTIVES: The aims of this study were to assess whether the transradial approach can be applied to treat complex chronic total occlusion (CTO) and to determine the predictors of transradial percutaneous coronary intervention (PCI) failure. BACKGROUND: Consistent data on the outcomes of transradial PCI for treating CTO are scarce. METHODS: Consecutive patients who were not receiving hemodialysis and had undergone PCI for CTO were enrolled. The clinical and angiographic characteristics, procedural details, and outcomes of the transradial and transfemoral procedures were examined. RESULTS: In total, 280 and 305 CTO PCI procedures involved transradial and transfemoral access, respectively. The technical success rates did not significantly differ in the entire cohort analysis and the propensity score-matched analysis (74.6% vs. 72.5%; p = 0.51 and 70.6% vs. 73.3%; p = 0.57). When only cases with J-CTO (Multicenter Chronic Total Occlusion Registry of Japan) scores of ≥3 were examined, the transradial group had a significantly lower success rate than the transfemoral group (35.7% vs. 58.2%; p = 0.04). The use of guiding catheter size <7 F (odds ratio [OR]: 5.50; p = 0.008), calcification (OR: 3.20; p = 0.001), occlusion length >20 mm (OR: 2.97; p < 0.001), and age (OR: 1.04; p = 0.03) were associated with transradial CTO PCI failure. CONCLUSIONS: Transradial PCI for CTO may be feasible in noncomplex cases, although complex cases still pose a challenge. In cases of transradial PCI for CTO, if possible, guiding catheter size ≥7 F should be selected regardless of lesion morphology. Furthermore, the transfemoral approach should be preferentially considered for complex CTO, particularly in cases with calcification.
OBJECTIVES: The aims of this study were to assess whether the transradial approach can be applied to treat complex chronic total occlusion (CTO) and to determine the predictors of transradial percutaneous coronary intervention (PCI) failure. BACKGROUND: Consistent data on the outcomes of transradial PCI for treating CTO are scarce. METHODS: Consecutive patients who were not receiving hemodialysis and had undergone PCI for CTO were enrolled. The clinical and angiographic characteristics, procedural details, and outcomes of the transradial and transfemoral procedures were examined. RESULTS: In total, 280 and 305 CTO PCI procedures involved transradial and transfemoral access, respectively. The technical success rates did not significantly differ in the entire cohort analysis and the propensity score-matched analysis (74.6% vs. 72.5%; p = 0.51 and 70.6% vs. 73.3%; p = 0.57). When only cases with J-CTO (Multicenter Chronic Total Occlusion Registry of Japan) scores of ≥3 were examined, the transradial group had a significantly lower success rate than the transfemoral group (35.7% vs. 58.2%; p = 0.04). The use of guiding catheter size <7 F (odds ratio [OR]: 5.50; p = 0.008), calcification (OR: 3.20; p = 0.001), occlusion length >20 mm (OR: 2.97; p < 0.001), and age (OR: 1.04; p = 0.03) were associated with transradial CTOPCI failure. CONCLUSIONS: Transradial PCI for CTO may be feasible in noncomplex cases, although complex cases still pose a challenge. In cases of transradial PCI for CTO, if possible, guiding catheter size ≥7 F should be selected regardless of lesion morphology. Furthermore, the transfemoral approach should be preferentially considered for complex CTO, particularly in cases with calcification.
Authors: Thomas A Meijers; Adel Aminian; Marleen van Wely; Koen Teeuwen; Thomas Schmitz; Maurits T Dirksen; Sudhir Rathore; René J van der Schaaf; Paul Knaapen; Joseph Dens; Juan F Iglesias; Pierfrancesco Agostoni; Vincent Roolvink; Miguel E Lemmert; Renicus S Hermanides; Niels van Royen; Maarten A H van Leeuwen Journal: J Am Heart Assoc Date: 2022-01-13 Impact factor: 6.106
Authors: Renato Francesco Maria Scalise; Armando Mariano Salito; Alberto Polimeni; Victoria Garcia-Ruiz; Vittorio Virga; Pierpaolo Frigione; Giuseppe Andò; Carlo Tumscitz; Francesco Costa Journal: J Clin Med Date: 2019-10-18 Impact factor: 4.241
Authors: Thomas A Meijers; Adel Aminian; Koen Teeuwen; Marleen van Wely; Thomas Schmitz; Maurits T Dirksen; Rene J van der Schaaf; Juan F Iglesias; Pierfrancesco Agostoni; Joseph Dens; Paul Knaapen; Sudhir Rathore; Jan Paul Ottervanger; Jan-Henk E Dambrink; Vincent Roolvink; A T Marcel Gosselink; Renicus S Hermanides; Niels van Royen; Maarten A H van Leeuwen Journal: BMJ Open Date: 2020-07-20 Impact factor: 2.692