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The comparison of efficacy and safety between transradial and transfemoral approach for chronic total occlusions
Wei-Chieh Lee1,2,3, Po-Jui Wu2, Chih-Yuan Fang2
1Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC.
Insights
Transradial access (TRA) offers higher procedural success and fewer vascular complications in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) compared to transfemoral access (TFA). Clinical outcomes were similar between the two approaches for CTO PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) remains challenging.
- Transradial access (TRA) and transfemoral access (TFA) are primary methods for PCI.
- Comparing outcomes of TRA versus TFA in CTO PCI is crucial for optimizing patient care.
Purpose of the Study:
- To compare the procedural outcomes and clinical efficacy of TRA versus TFA in patients undergoing CTO PCI.
- To evaluate differences in procedural success, complication rates, and major adverse cardiovascular events between TRA and TFA.
Main Methods:
- A meta-analysis of six observational studies published between January 1, 2015, and December 31, 2020.
- Analysis included 11,736 patients, examining baseline demographics, J-CTO scores, procedural details, and outcomes.
- Statistical comparison of procedural success, retrograde success, vascular complications, in-hospital death, and MACE between TRA and TFA groups.
Main Results:
- The TRA group demonstrated a higher procedural success rate (OR, 0.846) and significantly fewer vascular complications (OR, 0.323) compared to TFA.
- The TFA group was associated with a higher J-CTO score, longer procedural time, and greater contrast volume.
- No significant differences were observed in retrograde success rate, in-hospital death, or major adverse cardiovascular events between the two access methods.
Conclusions:
- Transradial access (TRA) is associated with improved procedural success and reduced vascular complications in chronic total occlusion percutaneous coronary intervention (CTO PCI).
- Despite differences in procedural metrics, both TRA and TFA yield similar retrograde success rates and clinical outcomes, including in-hospital death and major adverse cardiovascular events.
- TRA may be a preferred access route for CTO PCI due to its safety and efficacy profile.
Abstract:
This meta-analysis compared the outcomes of transradial access (TRA) and transfemoral access (TFA) in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in recent decades. We searched multiple databases for articles published between January 1, 2015, and December 31, 2020. Six observational studies with 11,736 patients were analyzed. Data included baseline demographics, Japan-chronic total occlusion (J-CTO) score, sheath size, PCI vessel, retrograde method, procedural time, fluoroscopy time, and contrast volume. The more prevalent target CTO vessel was the left coronary artery in the TRA group and the right coronary artery in the TFA group. Higher J-CTO score, longer procedural time, and more contrast volume were seen in the TFA group. In comparison, the TRA group had better procedural success rate (odds ratio (OR), 0.846; 95% confidence interval (CI) 0.749-0.956) and less vascular complications (OR, 0.323; 95% CI 0.203-0.515), but similar retrograde success rate (OR, 0.965; 95% CI 0.382-2.435). In-hospital death (OR, 0.527; 95% CI 0.187-1.489) and major adverse cardiovascular events (OR, 0.729; 95% CI 0.504-1.054) did not differ between the groups. Overall, fewer vascular complications and higher procedural success rates were noted in the TRA CTO PCI population. However, similar retrograde success rates and clinical outcomes were noted between the groups.
