Transradial and Transfemoral Approaches Compared for Coronary CTO Interventions

June 8, 2015—Noting that the efficacy and safety of transradial access in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has undergone limited study, Khaldoon Alaswad, MD, et al conducted an examination of the impact of transradial access on the procedural outcomes of CTO PCI, and the results were published in Catheterization and Cardiovascular Interventions (2015;85:1123–1129). The investigators compared the technique and outcomes of transradial versus transfemoral access across 650 CTO PCI cases performed between January 2012 and March 2014 at six centers in the United States.

The investigators concluded that transradial CTO PCI can be performed with similar rates of procedural success and complications as transfemoral CTO PCI, but it is associated with longer procedural and fluoroscopy times.

As summarized in Catheterization and Cardiovascular Interventions, the study population was mostly composed of men (87%) with a high frequency of diabetes mellitus (42%) and previous coronary artery bypass graft surgery (36%). The CTO target vessel was the right coronary (59%), left anterior descending (20%), or circumflex (17%) artery. Transradial access was used in 110 (17%) of the 650 cases, as follows: bilateral radial access (63%), bilateral radial access plus unilateral or bilateral femoral access (7%), unilateral radial access plus unilateral or bilateral femoral access (26%), and unilateral radial access (4%). The operators used 6- and 8-F guide catheters through the radial and femoral arteries, respectively. 

Compared to transfemoral, transradial cases had similar technical (92.6% vs 93%) and procedural (91.1% vs 90%) success and major complication rates (1.7% vs 1.8%). However, transradial access was associated with higher mean procedure (142 min vs 120 min) and fluoroscopy (58 min vs 49 min) times and number of crossing approach changes (0.7 vs 0.5), reported the investigators in Catheterization and Cardiovascular Interventions.