Complex Chronic Total Occlusion Revascularization - A Comparison of Biradial Versus Femoral Access

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Access

Background:

• Complex chronic total occlusion (CTO) cases frequently necessitate dual vascular access for successful percutaneous coronary intervention (PCI).
• Existing evidence indicates that radial artery access may be associated with lower success rates in complex CTO interventions compared to other approaches.

Purpose of the Study:

• To evaluate the efficacy and safety of biradial access compared to femoral artery access in patients undergoing dual-access CTO PCI.
• To identify predictors of revascularization failure in complex CTO cases.

Main Methods:

• Retrospective, single-center observational study of 150 patients undergoing dual-access CTO PCI (January 2014 - January 2018).
• Patients were stratified into biradial access (n=109) and femoral access (n=41) groups.
• Data collected included demographics, comorbidities, lesion characteristics, procedural outcomes, radiation dose, and contrast utilization. Univariate analyses identified predictors of failure.

Main Results:

• No significant difference in overall success rates between biradial (87%) and femoral (78%) access groups (P=.17).
• Matched cohort analysis confirmed equivalent success rates (80.6% vs 75.0%, P=.53).
• Biradial access was associated with significantly shorter procedure times (111 vs 147 min, P<.01), reduced radiation exposure (17,452 vs 23,651 cGy•cm², P<.01), and shorter hospital stays (0.38 vs 0.61 days, P=.02).

Conclusions:

• Biradial access is an effective and safe alternative for CTO PCI, demonstrating comparable success rates to femoral access.
• The biradial approach offers advantages including reduced procedure duration, radiation exposure, and length of hospital stay.
• Further prospective studies are warranted to definitively establish the superiority of biradial access in complex CTO interventions.