Related Experiment Video
Updated: Jan 28, 2026
Post-Myocardial Infarction Heart Failure in Closed-chest Coronary Occlusion/Reperfusion Model in Göttingen Minipigs and Landrace Pigs
Published on: April 17, 2021
Procedural Outcomes of Percutaneous Coronary Interventions for Chronic Total Occlusions Via the Radial Approach:
Peter Tajti1, Khaldoon Alaswad2, Dimitri Karmpaliotis3
1Minneapolis Heart Institute and the Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota; University of Szeged, Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, Szeged, Hungary.
Insights
Transradial access for chronic total occlusion percutaneous coronary intervention (CTO PCI) is increasingly common. This approach shows similar success rates and reduced major bleeding compared to femoral access, improving patient safety.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Access
Background:
- Radial access is known to enhance PCI safety, but its application in CTO PCI remains debated.
- The study addresses the ongoing discussion regarding the optimal vascular access route for complex coronary interventions.
Purpose of the Study:
- To evaluate the frequency and outcomes of using radial access for chronic total occlusion percutaneous coronary intervention (CTO PCI).
- To compare clinical, angiographic, and procedural characteristics between radial-only, radial-femoral, and femoral-only access in CTO PCI.
Main Methods:
- A retrospective analysis of 3,790 CTO PCI cases performed between 2012 and 2018 across 23 centers in the US, Europe, and Russia.
- Comparison of patient demographics, lesion complexity (J-CTO, PROGRESS CTO scores), procedural techniques (antegrade vs. retrograde), and access site utilization (radial-only, radial-femoral, femoral-only).
Main Results:
- Transradial access (RA and RFA) was utilized in 42% of CTO interventions, significantly increasing over time.
- RA patients were younger and had fewer comorbidities. Lesions treated with RA had lower complexity scores.
- Technical success (89%), procedural success (86%), and major complication rates (2.47%) were similar across all access groups, but major bleeding was significantly lower with RA (0.55%).
Conclusions:
- Transradial access is increasingly adopted for CTO PCI, demonstrating a favorable safety profile.
- CTO PCI via transradial access is associated with comparable technical and procedural success rates and a significant reduction in major bleeding events compared to femoral access.
Objectives:
This study examined the frequency and outcomes of radial access for chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
Background:
Radial access improves the safety of PCI, but its role in CTO PCI remains controversial.
Methods:
We compared the clinical, angiographic, and procedural characteristics of 3,790 CTO interventions performed between 2012 and 2018 via radial-only access (RA) (n = 747) radial-femoral access (RFA) (n = 844) and femoral-only access (n = 2,199) access at 23 centers in the United States, Europe, and Russia.
Results:
Patients' mean age was 65 ± 10 years, and 85% were men. Transradial access (RA and RFA) was used in 42% of CTO interventions and significantly increased over time from 11% in 2012 to 67% in 2018 (p < 0.001). RA patients were younger (age 62 ± 10 years vs. 64 ± 10 years and 65 ± 10 years; p < 0.001), less likely to have undergone prior coronary artery bypass graft surgery (18% vs. 39% and 35%; p < 0.001), and less likely to have undergone prior PCI (60% vs. 63% and 66%; p = 0.005) compared with those who underwent RFA and femoral-only access PCI. RA CTO PCI lesions had lower J-CTO (Multicenter CTO Registry in Japan) (2.1 ± 1.4 vs. 2.6 ± 1.3 and 2.5 ± 1.3; p < 0.001) and PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) complication (2.3 ± 1.9 vs. 3.2 ± 2.0 and 3.2 ± 1.9; p < 0.001) scores. The mean sheath size was significantly smaller in the RA group (6.6 ± 0.7 vs. 7.0 ± 0.6 and 7.3 ± 0.8; p < 0.0001), although it increased with lesion complexity. Antegrade dissection re-entry (20% vs. 33% and 32%; p < 0.001) was less commonly used with RA, whereas use of retrograde techniques was highest with RFA (47%). The overall rates of technical success (89% vs. 88% vs. 86%; p = 0.061), procedural success (86% vs. 85% vs. 85%; p = 0.528), and in-hospital major complication (2.47% vs. 3.40% vs. 2.18%; p = 0.830) were similar in all 3 groups, whereas major bleeding was lower in the RA group (0.55% vs. 1.94% and 0.88%; p = 0.013).
Conclusions:
Transradial access is increasingly being used for CTO PCI and is associated with similar technical and procedural success and lower major bleeding rates compared with femoral-only access interventions. (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention [PROGRESS CTO]; NCT02061436).
Related Concept Videos
01:05Total Internal Reflection Fluorescence Microscopy
01:12Total Voids in Concrete
01:23Chronic Pharyngitis
Etiology
It often arises from persistent viral or bacterial infections affecting sinuses and tonsils.
Additional contributing factors include inadequate dental hygiene, mouth breathing, recurring tonsillitis, allergic rhinitis, laryngopharyngeal reflux, and exposure to smoke, chemicals, and other environmental pollutants. Allergic reactions to pollen, mold, and pet dander, chronic cough, excessive voice usage,...
01:24Static, Stagnation, Dynamic and Total Pressure
01:24Chronic Pancreatitis I: Introduction
Pancreatitis is the inflammation of the pancreas, which occurs when the immune system becomes active and causes swelling, pain, and disruptions in organ function. Pancreatitis can manifest as either an acute or chronic condition.
Acute pancreatitis arises suddenly and lasts for a brief duration, while chronic pancreatitis is a long-term affliction...
01:17Chronic Bowel Disorders: Introduction
Irritable Bowel Syndrome (IBS) is a common disorder affecting the gastrointestinal tract. The distinctive feature is recurrent abdominal pain associated with altered bowel movements, manifesting as constipation, diarrhea, or fluctuating between both. The...