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Radial access for chronic total occlusion percutaneous coronary intervention: Insights from the PROGRESS-CTO registry

Bahadir Simsek1, Sevket Gorgulu2, Spyridon Kostantinis1

  • 1Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|July 23, 2022
PubMed

Insights

Radial access for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is increasingly used. This approach showed fewer access site complications with similar success rates and major adverse cardiovascular events compared to femoral access.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Access

Background:

  • Radial access is gaining popularity for percutaneous coronary intervention (PCI) in chronic total occlusion (CTO).
  • Understanding the clinical and procedural outcomes of radial versus femoral access in CTO PCI is crucial for optimizing patient care.
  • The Prospective Global Registry for the Study of CTO Intervention (PROGRESS-CTO) provides valuable data on this topic.

Purpose of the Study:

  • To compare the clinical characteristics and procedural outcomes of CTO PCI using radial versus femoral access.
  • To assess the safety and efficacy of radial access in CTO PCI.
  • To identify factors influencing the choice of access site in CTO PCI procedures.

Main Methods:

  • Analysis of data from the PROGRESS-CTO registry (NCT02061436) including 10,954 patients undergoing CTO PCI.
  • Comparison of patient demographics, comorbidities, and angiographic complexity between radial-only and femoral access groups.
  • Statistical analysis, including adjusted odds ratios, to evaluate access site complications, technical success, and major adverse cardiovascular events (MACE).

Main Results:

  • Radial-only access was utilized in 24% of CTO PCI cases.
  • Patients undergoing radial-only access were younger, more likely male, and had fewer comorbidities.
  • Radial-only access was associated with significantly lower access site complications (OR: 0.45) but similar technical success (OR: 0.87) and MACE (OR: 0.65) compared to femoral access, after adjusting for confounders.

Conclusions:

  • Radial access is a safe and effective alternative to femoral access for CTO PCI.
  • The use of radial access in CTO PCI is associated with reduced access site complications without compromising procedural success or major adverse cardiovascular events.
  • Radial access should be considered a primary approach for CTO PCI, particularly in carefully selected patient populations.

Keywords:
chronic total occlusioncomplicationsfemoral accesspercutaneous coronary interventionradial access

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