Transradial CTO PCI may be feasible for noncomplex cases
medwireNews: Transradial percutaneous coronary intervention (PCI) could be feasible for the treatment of noncomplex chronic total occlusions (CTO), but complex cases may require a transfemoral approach, Japanese researchers report.
Yutaka Tanaka and colleagues, from Shonan Kamakura General Hospital, analyzed PCI outcomes among 508 patients treated for 585 CTO lesions at their center over a 10-year period.
The found that the rates of technical success – defined as the restoration of an antegrade TIMI flow grade of 3 with less than 50% final residual stenosis – did not significantly differ between 280 procedures performed using transradial access and 305 with transfemoral access, at 74.6% versus 72.5%.
Similarly, when propensity-score matching was carried out to reduce the effect of selection bias, technical success rates were 70.6% for 187 transradial PCI procedures and 73.3% for 187 matched transfemoral procedures.
However, in the group of patients with Multicenter Chronic Total Occlusion Registry of Japan (J-CTO) scores of 3 or higher, indicating high procedural difficulty, the prevalence of technical success was significantly lower among those undergoing transradial procedures (35.7 vs 58.2%), suggesting that “the J-CTO score can be applied to predict the feasibility of transradial CTO PCI,” report the authors.
They also found that the use of guiding catheter size of less than 7-F, calcifications, occlusions longer than 20 mm, and older age were associated with transradial procedure failure, with corresponding odds ratios of 5.50, 3.20, 2.97, and 1.04.
“If possible, guiding catheter size ≥7-F should be selected, regardless of lesion morphology, say Tanaka and team in JACC: Cardiovascular Interventions. “Moreover, the transfemoral approach should be preferentially considered for CTO, particularly in cases with moderate or severe calcification.”
However, the authors of an accompanying editorial comment, Stéphane Rinfret and Rustem Dautov (both from McGill University, Montreal, Quebec, Canada), caution that “this study should not be considered as a clean comparison of access sites for CTO PCI.”
They note that catheters smaller than size 7-F were used in over 90% of patients undergoing transradial PCI, whereas catheters of 7-F or larger were used in at least 95% of transfemoral patients, resulting in “a clear bias toward smaller catheters in the radial group.”
“[M]ost importantly, the debate of comparing radial with femoral for CTO PCI is somewhat passé, because both approaches offer advantages and limitations that need to be understood,” they add.
And they conclude that: “[T]here is no need to be dogmatic: CTO PCI operators need to master both approaches.”
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