Author + information
- Rustem Dautov,
- Henrique Ribeiro,
- Claire Gibrat,
- Can M. Nguyen and
- Stephane Rinfret
The use of the transradial approach (TRA) in percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) is still limited. We describe one of the largest single-center experiences, which evolved from 6F to a novel sheathless technique (ST) with regular 8F antegrade guides. We evaluated the safety of this technique.
We compared our earlier experience (EE) using 6-7F catheters to the latest one (LE), introduced in March 2013 favoring the use of 8F, either from the radial or the femoral (TFA). We then compared ST vs. standard TRA or TFA. The in-hospital outcomes of interest were technical success, contrast, radiation, procedure time, and the incidence of major vascular or bleeding complications. In a sub-sample, we examined radial patency using Doppler at 3-6 months.
From 01.2010 to 03.2015, a total of 409 CTO PCIs were performed: 223 during the EE, whereas 186 in LE favoring 8F catheters. Despite an increase of the proportion of patients with very difficult lesions (J-CTO score ≥ 3) in LE (from 39% to 51%, p=0.02), we did not observe any difference with regards to success, procedure time, or in the incidence of major complications. However, contrast use was higher in LE (355±152 ml vs. 292±124 ml, p<0.0001). Over the 2 years of LE, 92 patients underwent their CTO PCI with a ST and 94 without a ST. Patients not treated with a ST were more likely to be females (33% vs 5% in ST group, p<0.0001), diabetic (51% vs 36%, p=0.04) and to undergo their CTO PCI with at least one TFA. Again, we did not observe any difference with regards to success, procedure time, or in the incidence of major vascular or bleeding complications, which were very low in both groups. The ST did not increase procedure time (143 min vs 154 min with the sheath, p=NS). The mid-term radial Doppler evaluation of 28 patients demonstrated 7.1% radial occlusions with the 8F ST, while 3.6% with 6F in the contralateral radial artery (control).
A liberal use of the TRA with selected TFA for CTO PCI is associated with low complication rates. Our 8F sheathless technique for TRA in CTO PCI is feasible and safe when compared to the use of 6F standard PCI and provides unlimited spectrum of CTO PCI technique available to transfemoral CTO operators.