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Distal Radial Access in Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the PROGRESS-CTO

Ilias Nikolakopoulos, Taral Patel, Brian K Jefferson

  • 1Minneapolis Heart Institute, 920 E. 28th Street #300, Minneapolis, MN 55407 USA. esbrilakis@gmail.com.

The Journal of Invasive Cardiology
|August 26, 2021
PubMed

Insights

Distal radial access (dRA) for chronic total occlusion percutaneous coronary intervention (CTO-PCI) shows similar success and complication risks compared to proximal radial access (pRA). dRA also led to lower radiation doses and reduced tamponade rates in this study.

Area of Science:

  • Interventional Cardiology
  • Vascular Access Techniques
  • Cardiovascular Interventions

Background:

  • Limited studies exist on distal radial access (dRA) outcomes for chronic total occlusion percutaneous coronary intervention (CTO-PCI).
  • Radial artery access is increasingly preferred for PCI due to lower complication rates compared to femoral access.

Purpose of the Study:

  • To compare the clinical, angiographic, and procedural outcomes of CTO-PCI performed via dRA versus proximal radial access (pRA).
  • To evaluate the safety and efficacy of dRA in the context of complex PCI procedures.

Main Methods:

  • A large, multicenter registry study compared 120 CTO-PCIs using dRA with 2625 CTO-PCIs using pRA.
  • Clinical, angiographic, and procedural characteristics were analyzed, including PROGRESS-CTO and J-CTO scores.
  • Technical success rates and major periprocedural adverse cardiac events were assessed.

Main Results:

  • Technical success rates were similar between dRA (90%) and pRA (86%).
  • The incidence of major adverse cardiac events was comparable (0.8% vs 2.4%).
  • dRA was associated with significantly lower rates of tamponade requiring pericardiocentesis (0% vs 4.69%) and reduced air kerma radiation dose (median 1.7 Gy vs 2.27 Gy).

Conclusions:

  • Distal radial access (dRA) is a viable and safe alternative to proximal radial access (pRA) for CTO-PCI.
  • dRA offers comparable procedural success with a potentially lower risk of specific complications like tamponade and reduced radiation exposure.
Abstract

Keywords:
coronary occlusionpercutaneous coronary interventionradial artery

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