Abstract 15455: Radial Versus Femoral Access for Percutaneous Coronary Intervention in Patients with Chronic Total Occlusion
Introduction Femoral access (FEM) is usually employed in percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) because this is considered to provide better catheter support, and allows the use of larger diameter guiding catheters.
Hypothesis We assessed the hypothesis that the use of radial access (RAD), which is typically 6-Fr catheter compatible, is comparable to FEM with respect to procedural success for CTO.
Methods The study included all consecutive patients undergoing PCI for CTO at 3 tertiary PCI centres between January 2004 and December 2011. CTO lesions were graded as easy (score of 0), intermediate (1), difficult (2), and "very difficult" (≥3), according to the angiographic J-CTO score. A multivariable mixed effect logistic regression for clustered data was used to assess the impact of RAD on PCI success after adjustment for patient characteristics, lesion difficulty graded by angiographic score, vessel site, procedural techniques.
Results A total of 1249 patients, median age 63 yrs-old (55-72, 25th-75th percentile) undergoing PCI for 1402 CTO were included. RAD was used in 848 (60.5%) lesions. The use of 7-Fr (0.8% vs. 6.7%, p<0.001) or 8-Fr (0% vs 4.15%, p <0.001) guiding catheters was significantly lower in the RAD group than in the FEM group. The prevalence of difficult lesions (J-CTO score ≥ 2) was lower in the RAD group than in the FEM group (39.4% vs 48.4%, p=0.001). The use of 7-Fr or 8-Fr guiding catheters was higher in lesions with J-CTO score ≥ 2 than in those with J-CTO score (6.1% vs 2.1%, p<0.001). PCI success rate was slightly higher in the RAD group than in the FEM group (72.6% vs. 68.4%), although this difference did not achieve the statistical significance (p=0.09). At multivariable logistic regression the use of RAD, as compared to FEM, was not associated with procedural success (odds ratio 1.14, 95% confidence interval (CI) 0.88-1.48, p=0.33).
Conclusions The use of RAD for PCI of CTO is feasible in the vast majority of lesions and it is associated with a comparable success rate to that achieved using FEM.
- © 2012 by American Heart Association, Inc.