Fully Transradial Approach Studied for PCI of CTO Applying the Hybrid Algorithm
September 11, 2017—Online in Circulation: Cardiovascular Interventions, Erik Jan Bakker, MD, et al published findings from a study that sought to assess technical success, complication rates, and procedural efficiency in a fully transradial approach (fTRA) and a transfemoral approach (TFA) in a large prospective European registry adopting the hybrid algorithm for chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
The investigators evaluated data in RECHARGE, a registry of the CrossBoss catheter (Boston Scientific Corporation) and hybrid procedures in France, the Netherlands, Belgium, and the United Kingdom.
As summarized Circulation: Cardiovascular Interventions, the investigators analyzed 1,253 CTO-PCI procedures performed according to the hybrid protocol in 17 European centers, comparing fTRA (single or biradial access) and TFA (single or bifemoral or combined radial and femoral access).
The fTRA method was applied in 306 (24%) cases and TFA was applied in 947 (76%) cases. The average Japanese CTO score was 2.1 ± 1.2 for the fTRA cases and 2.3 ± 1.1 for the TFA cases (P = .06). Technical success was achieved in 85% of the fTRA cases and in 86% of the TFA cases (P = .51). Technical success was comparable for fTRA and TFA in different Japanese CTO score subgroups after multivariable analysis and after propensity adjustment. In-hospital major adverse cardiac and cerebral events occurred in 2% of fTRA cases and 2.9% of TFA cases (P = .4).
Major access site bleeding occurred in 0.3% of fTRA cases and 0.5% of TFA cases (P = .66). fTRA compared with TFA had similar procedural duration (80 minutes [54–120 minutes] vs 90 minutes [60–121 minutes]; P = .07), similar radiation dose (dose area product, 89 Gray X cm2 [52–163 Gray X cm2] vs 101 Gray X cm2 [59–171 Gray X cm2]; P = .06), and lower contrast agent use (200 mL [150–310 mL] vs 250 mL [200–350 mL]; P < .01).
CTO PCI using fTRA is a valid alternative to TFA with a high rate of success, low complication rates, and no decrease in procedural efficiency, concluded the investigators in Circulation: Cardiovascular Interventions.