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Feasibility and Safety of Chronic Total Occlusion Percutaneous Coronary Intervention via Distal Transradial Access
Cheng-Jui Lin1, Wei-Chieh Lee1, Chieh-Ho Lee1
1Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Insights
Distal transradial access (dTRA) with Glidesheath is a safe and feasible approach for complex chronic total occlusion (CTO) percutaneous coronary intervention (PCI). This method demonstrated low rates of access-site complications and distal radial artery occlusion, ensuring high procedural success.
Area of Science:
- Interventional Cardiology
- Vascular Access Techniques
- Coronary Artery Disease Management
Background:
- Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) presents unique challenges.
- Traditional transradial access may have limitations for complex CTO procedures.
- Distal transradial access (dTRA) offers a potential alternative for improved outcomes.
Purpose of the Study:
- To evaluate the feasibility and safety of CTO-PCI using distal transradial access (dTRA).
- To assess access-site and procedural complication rates associated with dTRA for CTO intervention.
- To determine the procedural success rate of CTO-PCI via dTRA.
Main Methods:
- A prospective study of 298 patients undergoing CTO-PCI via dTRA between April 2017 and December 2019.
- Detailed recording of demographic and procedural characteristics, including access time and procedure duration.
- Monitoring of access-site vascular complications, procedural complications, mortality, and radial artery occlusion.
Main Results:
- High technical success rates for both left (96.5%) and right (97.7%) radial snuffbox access.
- Low incidence of severe access-site vascular complications (0.7%) and distal radial artery occlusion (0.5%).
- Overall procedural success rate of 93.5%, with higher success in antegrade (96.5%) versus retrograde (87.7%) approaches.
Conclusions:
- Distal transradial access (dTRA) combined with Glidesheath is a safe and feasible strategy for complex CTO interventions.
- The technique is associated with low rates of severe access-site complications and distal radial artery occlusion.
- dTRA provides a viable and effective alternative access route for CTO-PCI, contributing to high procedural success.
Abstract:
Aims: The current study aims to verify the feasibility and safety of chronic total occlusion (CTO)-percutaneous coronary intervention (PCI) via the distal transradial access (dTRA). Methods: Between April 2017 and December 2019, 298 patients who underwent CTO PCI via dTRA were enrolled in this study. The baseline demographic and procedural characteristics were listed and compared between groups. The incidences of access-site vascular complications and procedural complications and mortality were recorded. Results: The mean J-CTO (Japanese chronic total occlusion) score was 2.6 ± 0.9 points. The mean access time was 4.6 ± 2.9 min, and the mean procedure time was 115.9 ± 55.6 min. Left radial snuffbox access was performed successfully in 286 patients (96.5%), and right radial snuffbox access was performed successfully in 133 patients (97.7%). Bilateral radial snuffbox access was performed in 107 patients (35.9%). 400 dTRA (95.5%) received glidesheath for CTO intervention. Two patients (0.7%) developed severe access-site vascular complications. None of the patients experienced severe radial artery spasm and only 2 patients (0.5%) developed radial artery occlusion during the follow-up period. The overall procedural success rate was 93.5%. The procedural success rate was 96.5% in patients with antegrade approach and 87.7% in patients with retrograde approach. Conclusions: It is both safe and feasible to use dTRA plus Glidesheath for complex CTO intervention. The incidences of procedure-related complications and severe access-site vascular complications, and distal radial artery occlusion were low.
