Author + information
- Received September 12, 2018
- Revision received October 25, 2018
- Accepted November 15, 2018
- Published online February 18, 2019.
- Peter Tajti, MDa,b,
- Khaldoon Alaswad, MDc,
- Dimitri Karmpaliotis, MD, PhDd,
- Farouc A. Jaffer, MD, PhDe,
- Robert W. Yeh, MDf,
- Mitul Patel, MDg,
- Ehtisham Mahmud, MDg,
- James W. Choi, MDh,
- M. Nicholas Burke, MDa,
- Anthony H. Doing, MDi,
- Phil Dattilo, MDi,
- Catalin Toma, MDj,
- A.J. Conrad Smith, MDj,
- Barry F. Uretsky, MDk,
- Elizabeth Holper, MDl,
- Srinivasa Potluri, MDl,
- R. Michael Wyman, MDm,
- David E. Kandzari, MDn,
- Santiago Garcia, MDo,
- Oleg Krestyaninov, MDp,
- Dmitrii Khelimskii, MDp,
- Michalis Koutouzis, MDq,
- Ioannis Tsiafoutis, MDq,
- Jaikirshan J. Khatri, MDr,
- Wissam Jaber, MDs,
- Habib Samady, MDs,
- Brian Jefferson, MDt,
- Taral Patel, MDt,
- Shuaib Abdullah, MDu,
- Jeffrey W. Moses, MDd,
- Nicholas J. Lembo, MDd,
- Manish Parikh, MDd,
- Ajay J. Kirtane, MDd,
- Ziad A. Ali, MDd,
- Darshan Doshi, MDd,
- Iosif Xenogiannis, MDa,
- Larissa I. Stanberry, PhDa,
- Bavana V. Rangan, BDS, MPHa,
- Imre Ungi, MD, PhDb,
- Subhash Banerjee, MDu and
- Emmanouil S. Brilakis, MD, PhDa,∗ ()
- aMinneapolis Heart Institute and the Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
- bUniversity of Szeged, Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, Szeged, Hungary
- cHenry Ford Hospital, Detroit, Michigan
- dColumbia University, New York, New York
- eMassachusetts General Hospital, Boston, Massachusetts
- fBeth Israel Deaconess Medical Center, Boston, Massachusetts
- gVA San Diego Healthcare System and University of California, San Diego, La Jolla, California
- hBaylor Heart and Vascular Hospital, Dallas, Texas
- iMedical Center of the Rockies, Loveland, Colorado
- jUniversity of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- kVA Central Arkansas Healthcare System, Little Rock, Arkansas
- lThe Heart Hospital Baylor Plano, Plano, Texas
- mTorrance Memorial Medical Center, Torrance, California
- nPiedmont Heart Institute, Atlanta, Georgia
- oVA Minneapolis Healthcare System and University of Minnesota, Minneapolis, Minnesota
- pMeshalkin Siberian Federal Biomedical Research Center, Ministry of Health of Russian Federation, Novosibirsk, Russian Federation
- qKorgialeneio-Benakeio Hellenic Red Cross General Hospital of Athens, Athens, Greece
- rCleveland Clinic, Cleveland, Ohio
- sEmory University, Atlanta, Georgia
- tTristar Centennial Medical Center, Nashville, Tennessee
- uVA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
- ↵∗Address for correspondence:
Dr. Emmanouil S. Brilakis, Minneapolis Heart Institute, 920 East 28th Street, #300, Minneapolis, Minnesota 55407.
Objectives This study examined the frequency and outcomes of radial access for chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
Background Radial access improves the safety of PCI, but its role in CTO PCI remains controversial.
Methods We compared the clinical, angiographic, and procedural characteristics of 3,790 CTO interventions performed between 2012 and 2018 via radial-only access (RA) (n = 747) radial-femoral access (RFA) (n = 844) and femoral-only access (n = 2,199) access at 23 centers in the United States, Europe, and Russia.
Results Patients’ mean age was 65 ± 10 years, and 85% were men. Transradial access (RA and RFA) was used in 42% of CTO interventions and significantly increased over time from 11% in 2012 to 67% in 2018 (p < 0.001). RA patients were younger (age 62 ± 10 years vs. 64 ± 10 years and 65 ± 10 years; p < 0.001), less likely to have undergone prior coronary artery bypass graft surgery (18% vs. 39% and 35%; p < 0.001), and less likely to have undergone prior PCI (60% vs. 63% and 66%; p = 0.005) compared with those who underwent RFA and femoral-only access PCI. RA CTO PCI lesions had lower J-CTO (Multicenter CTO Registry in Japan) (2.1 ± 1.4 vs. 2.6 ± 1.3 and 2.5 ± 1.3; p < 0.001) and PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) complication (2.3 ± 1.9 vs. 3.2 ± 2.0 and 3.2 ± 1.9; p < 0.001) scores. The mean sheath size was significantly smaller in the RA group (6.6 ± 0.7 vs. 7.0 ± 0.6 and 7.3 ± 0.8; p < 0.0001), although it increased with lesion complexity. Antegrade dissection re-entry (20% vs. 33% and 32%; p < 0.001) was less commonly used with RA, whereas use of retrograde techniques was highest with RFA (47%). The overall rates of technical success (89% vs. 88% vs. 86%; p = 0.061), procedural success (86% vs. 85% vs. 85%; p = 0.528), and in-hospital major complication (2.47% vs. 3.40% vs. 2.18%; p = 0.830) were similar in all 3 groups, whereas major bleeding was lower in the RA group (0.55% vs. 1.94% and 0.88%; p = 0.013).
Conclusions Transradial access is increasingly being used for CTO PCI and is associated with similar technical and procedural success and lower major bleeding rates compared with femoral-only access interventions. (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention [PROGRESS CTO]; NCT02061436)
The PROGRESS CTO registry has received support from the Abbott Northwestern Hospital Foundation. Dr. Karmpaliotis has received speaking honoraria from Abbott Vascular, Boston Scientific, Medtronic, and Vascular Solutions. Dr. Alaswad has received consulting fees from Terumo and Boston Scientific; and is a consultant (no financial compensation) for Abbott Laboratories. Dr. Jaffer is a consultant for Abbott Vascular, Boston Scientific, Siemens, and Philips; and has received research grants from Canon, Siemens, and the National Institutes of Health. Dr. Yeh has received a Career Development Award (1K23HL118138) from the National Heart, Lung, and Blood Institute. Dr. Patel is a member of the Speakers Bureau of AstraZeneca. Dr. Mahmud has received consulting fees from Medtronic and Corindus; speaking fees from Medtronic, Corindus, and Abbott Vascular; educational program fees from Abbott Vascular; and clinical events committee fees from St. Jude Medical. Dr. Burke has received consulting and speaking honoraria from Abbott Vascular and Boston Scientific. Dr. Wyman has received honoraria, consulting, and speaking fees from Boston Scientific, Abbott Vascular, and Asahi Intecc. Dr. Kandzari has received research and grant support and consulting honoraria from Boston Scientific and Medtronic Cardiovascular; and research and grant support from Abbott. Dr. Garcia has received consulting fees from Medtronic. Dr. Khatri has received a research grant from Asahi Intecc; and consulting and speaking honoraria from Abbott Vascular, Philips, and Abiomed. Dr. Moses is a consultant to Boston Scientific and Abiomed. Dr. Lembo is a member of the Speakers Bureau of Medtronic; and is a member of advisory boards for Abbott Vascular and Medtronic. Dr. Parikh is a member of the Speaker Bureau of Abbot Vascular, Medtronic, Cardiovascular Systems Inc., Boston Scientific, and Trireme; and is a member of advisory boards for Medtronic, Abbott Vascular, and Philips. Dr. Kirtane has received institutional research grants to Columbia University from Boston Scientific, Medtronic, Abbott Vascular, Abiomed, St. Jude Medical, Vascular Dynamics, GlaxoSmithKline, and Eli Lilly. Dr. Ali has received consulting fees and honoraria from St. Jude Medical and AstraZeneca Pharmaceuticals; has ownership interest, partnership, and principal in Shockwave Medical and VitaBx; and has received research grants from Medtronic and St. Jude Medical. Dr. Rangan has received research grants from InfraReDx and Spectranetics. Dr. Banerjee has received research grants from Gilead and The Medicines Company; has received consulting and speaking honoraria from Covidien and Medtronic; has ownership in MDCARE Global (spouse); and has intellectual property in HygeiaTel. Dr. Brilakis has receiving consulting and speaking honoraria from Abbott Vascular, American Heart Association, Amgen, Boston Scientific, Cardiovascular Systems Inc., Elsevier, GE Healthcare, and Medtronic; has received research support from Regeneron, Siemens, and Osprey; is a member of the board of directors of the Cardiovascular Innovations Foundation; and is a member of the board of trustees of the Society of Cardiovascular Angiography and Interventions. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 12, 2018.
- Revision received October 25, 2018.
- Accepted November 15, 2018.
- 2019 American College of Cardiology Foundation
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