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Published on: November 19, 2020
Radial Versus Femoral Access in Chronic Total Occlusion Percutaneous Coronary Intervention
Michael Megaly1,2, Aris Karatasakis3, Bishoy Abraham4
1Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (M.M., J.J., M.N.B., E.S.B.).
Insights
Radial access (RA) in chronic total occlusion (CTO) percutaneous coronary intervention is safe and effective, showing similar technical success but fewer complications compared to femoral access. This approach is associated with reduced bleeding and access-site issues, making it a favorable option for CTO PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Access
Background:
- Radial access (RA) is increasingly utilized for percutaneous coronary intervention (PCI) in chronic total occlusions (CTOs).
- Concerns exist regarding RA's safety and efficacy due to procedural complexity and the need for robust guide catheter support.
- Existing data comparing RA with femoral access (FA) in CTO PCI requires comprehensive synthesis.
Purpose of the Study:
- To systematically review and meta-analyze studies comparing radial access (RA) versus femoral access (FA) for chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
- To evaluate key outcomes including major bleeding, access-site complications, in-hospital major adverse events, and technical success.
Main Methods:
- A systematic review and meta-analysis of published studies through November 2018 was conducted.
- Nine observational studies involving 10,590 patients and 10,617 CTO lesions were included.
- Outcomes were compared between patients undergoing CTO PCI via RA and FA.
Main Results:
- CTO lesions treated with RA were associated with a lower Japan-CTO score, indicating less complexity.
- RA demonstrated similar technical success rates (78.7% vs. 78.5%) compared to FA.
- RA was associated with significantly lower rates of access-site complications (0.73% vs. 1.79%) and major bleeding (0.18% vs. 0.9%) than FA.
Conclusions:
- Radial access is a safe and effective alternative to femoral access for chronic total occlusion percutaneous coronary intervention.
- RA is associated with a reduced risk of access-site complications and major bleeding.
- Despite being used for less complex lesions, RA offers comparable technical success to femoral access in CTO PCI.
Abstract:
Background Radial access (RA) is increasingly used in chronic total occlusion (CTO) percutaneous coronary intervention with encouraging results. However, there are concerns about its safety and efficacy because of higher complexity and the need for strong guide catheter support. Methods and Results We performed a systematic review and meta-analysis of all studies published through November 2018 reporting the outcomes of RA versus femoral access in CTO percutaneous coronary intervention. Outcomes included major bleeding, access-site complications, in-hospital major adverse events, and technical success. Nine observational studies with 10 590 patients (10 617 lesions) were included in the meta-analysis. CTO lesions attempted using RA had lower Japan-CTO score (2.3±1.2 versus 2.5±1.3; P<0.001). Use of RA was associated with similar technical success (78.7% versus 78.5%; odds ratio, 1.11; 95% CI, 0.94-1.31; P=0.24; I2=23%), lower risk of access-site complications (0.73% versus 1.79%; odds ratio, 0.34; 95% CI, 0.22-0.51; P<0.001; I2=0%) and major bleeding (0.18% versus 0.9%; odds ratio, 0.22; 95% CI, 0.10-0.45; P<0.001; I2=0%), and similar risk of in-hospital adverse events and in-hospital mortality (odds ratio, 0.36; 95% CI, 0.12-1.07; P=0.07; I2=0%) as compared to femoral access. Results were similar when analyzing radial-only versus any femoral access and when excluding the largest study. Conclusions As compared with femoral access, RA is used in CTO percutaneous coronary intervention of less complex lesions and is associated with fewer access-site complications and major bleeding and comparable technical success.
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