Abstract 15376: A Comparison of the Success Rates of Transradial and Transfemoral Approaches for Percutaneous Coronary Intervention of Chronic Total Occlusions.
Purpose: Chronic total occlusions (CTOs) are found in approximately 30% of patients with coronary artery disease and represent the most difficult group for treatment by percutaneous coronary intervention (PCI) with a lower angiographic success rate. Transradial coronary intervention is a safe and effective method of coronary revascularisation though the efficacy of this approach in CTOs has not been well studied.
Methods: All patients treated with PCI for CTOs between January 2004 and December 2009 were retrospectively identified from a dedicated database. We compared the success rates via the transradial approach (TRA) and transfemoral approach (TFA) with attention to the lesion characteristics and techniques applied.
Results: 979 patients (age 63.2 ± 11.6 years, 87.3% male) were studied. Baseline demographics were similar in all groups. Lesion characteristics were similar between the two groups with no difference in lesion length, calcification or proximal vessel tortuosity. There was a significant difference in the rate of bifurcations performed via the TRA and TFA (29.1% vs. 14.6%, p<0.0001). Parallel wire technique and retrograde recanalisation were used more frequently from the TFA. TRA was associated with an increased use of anchoring balloons. Sheath sizes > 6 French were used in 20/979(2%). Larger sheath size was associated with a higher rate of parallel wire technique (p=0.0004), retrograde recanalisation (p<0.0001) and tornus use (p=0.027). There was no difference in the use of anchoring balloon between larger and smaller sheath sizes.
Conclusions: TRA has equivalent success rates to TFA in patients with similar lesion characteristics, requires less invasive sheath sizes and allows complex techniques such as retrograde recanalisation as with TFA.
- © 2010 by American Heart Association, Inc.