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Ulnar Artery Access in Chronic Total Occlusion Percutaneous Coronary Intervention

Sant Kumar1, Dimitrios Strepkos2, Michaella Alexandrou2

  • 1Creighton University School of Medicine, Phoenix, Arizona, USA.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|January 7, 2026
PubMed

Insights

Ulnar artery access for chronic total occlusion percutaneous coronary intervention (CTO PCI) is safe and effective, showing similar outcomes to radial and femoral access. This approach, used in less complex cases, warrants further investigation.

Area of Science:

  • Cardiovascular Interventions
  • Vascular Access Techniques

Background:

  • Ulnar artery access presents a potential alternative for chronic total occlusion percutaneous coronary intervention (CTO PCI).
  • Limited data currently exists on its utilization and outcomes compared to traditional access routes.

Purpose of the Study:

  • To evaluate the use, patient demographics, and in-hospital results of ulnar artery access versus radial and non-ulnar access in CTO PCI.
  • To compare major adverse cardiovascular events (MACE) and technical success rates between different access sites.

Main Methods:

  • Analysis of 18,826 patients undergoing CTO PCI from 2012-2024 across 51 centers in the PROGRESS-CTO Registry.
  • Patients were categorized into three groups: no radial/ulnar access, radial access only, and ulnar access.
  • In-hospital MACE, technical success, and access complications were primary and secondary endpoints, analyzed using multivariable logistic regression.

Main Results:

  • Ulnar access was utilized in 0.8% of cases (147 patients), who were younger and had a higher prevalence of prior PCI and peripheral arterial disease.
  • Lesion complexity was lower in the ulnar access group.
  • In-hospital outcomes including MACE (2.7%), technical success (83.7%), and access complications (0.7%) were similar across all access groups.

Conclusions:

  • Ulnar artery access in CTO PCI, though used infrequently, demonstrates comparable safety and efficacy to radial and femoral access in this large series.
  • The observed use in lower complexity cases suggests a need for prospective studies to confirm these hypothesis-generating findings.
Abstract

Keywords:
chronic total occlusionpercutaneous coronary interventionulnar artery accessvascular access

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