• Peter Tajti, Khaldoon Alaswad, Dimitri Karmpaliotis, Farouc A Jaffer, Robert W Yeh, Mitul Patel, Ehtisham Mahmud, James W Choi, M Nicholas Burke, Anthony H Doing, Phil Dattilo, Catalin Toma, Smith A J Conrad AJC University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania., Barry F Uretsky, Elizabeth Holper, Srinivasa Potluri, R Michael Wyman, David E Kandzari, Santiago Garcia, Oleg Krestyaninov, Dmitrii Khelimskii, Michalis Koutouzis, Ioannis Tsiafoutis, Jaikirshan J Khatri, Wissam Jaber, Habib Samady, Brian Jefferson, Taral Patel, Shuaib Abdullah, Jeffrey W Moses, Nicholas J Lembo, Manish Parikh, Ajay J Kirtane, Ziad A Ali, Darshan Doshi, Iosif Xenogiannis, Larissa I Stanberry, Bavana V Rangan, Imre Ungi, Subhash Banerjee, and Emmanouil S Brilakis.
• Minneapolis Heart Institute and the Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota; University of Szeged, Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, Szeged, Hungary.
• JACC Cardiovasc Interv. 2019 Feb 25; 12 (4): 346-358.

ObjectivesThis study examined the frequency and outcomes of radial access for chronic total occlusion (CTO) percutaneous coronary intervention (PCI).BackgroundRadial access improves the safety of PCI, but its role in CTO PCI remains controversial.MethodsWe 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.ResultsPatients' 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).ConclusionsTransradial 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).Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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