2
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Chakravartti J, Feser WJ, Plomondon ME, Valle JA, Rao SV, Gutierrez JA, Grunwald GK, Gunzburger E, Swaminathan RV. Access Site Selection and Outcomes for Chronic Total Occlusion Percutaneous Coronary Interventions: Insights from the VA CART Program. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100440. [PMID: 39132361 PMCID: PMC11308032 DOI: 10.1016/j.jscai.2022.100440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/25/2022] [Accepted: 08/01/2022] [Indexed: 08/13/2024]
Abstract
Background There has been increasing use of transradial access (TRA) for non-chronic total occlusion (CTO) percutaneous coronary intervention (PCI). There are limited data on TRA for CTO PCI. The objectives of this study were to assess the temporal trends in the use of TRA versus transfemoral access (TFA), identify procedural and lesion characteristics associated with the use of TRA and TFA, and evaluate the association of access site with procedural complications and technical success among veterans undergoing attempted CTO PCI. Methods We performed a retrospective analysis of veteran patients who underwent attempted CTO PCI to compare outcomes between TRA and TFA. Patients who had undergone attempted PCI of at least 1 CTO were included. Propensity score matching was used to evaluate the composite primary outcome of major procedural complications, in-hospital bleeding, or 30-day mortality and the secondary outcome of procedural success. Results In total, 4609 patients underwent attempted CTO PCI during 2010-2017. Rates of TRA for CTO PCI increased significantly, from 7% in 2010 to 38% in 2017 (P trend < .01). A greater percentage of CTO lesions in the TFA group was calcified and >20.0 mm in length. TRA was not associated with a reduction in the composite primary outcome (TRA 3.3% vs TFA 4.0%, P = .47) or procedural success (TRA 66.6% vs TFA 65.7%, P = .74) compared with TFA. Conclusions In this retrospective analysis of patients who underwent attempted CTO PCI, the proportion of TRA for CTO PCI has increased over time but was not associated with a greater safety or procedural success than TFA.
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Affiliation(s)
| | - William J. Feser
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, Colorado
| | - Mary E. Plomondon
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado
- CART Program, Office of Quality and Patient Safety, Veterans Health Administration, Washington, DC
| | - Javier A. Valle
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado
- Section of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Sunil V. Rao
- Department of Medicine, Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
- Section of Cardiology, Department of Medicine, Durham VA Healthcare System, Durham, North Carolina
| | - J. Antonio Gutierrez
- Department of Medicine, Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
- Section of Cardiology, Department of Medicine, Durham VA Healthcare System, Durham, North Carolina
| | - Gary K. Grunwald
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, Colorado
| | | | - Rajesh V. Swaminathan
- Department of Medicine, Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
- Section of Cardiology, Department of Medicine, Durham VA Healthcare System, Durham, North Carolina
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10
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Megaly M, Karatasakis A, Abraham B, Jensen J, Saad M, Omer M, Elbadawi A, Sandoval Y, Shishehbor MH, Banerjee S, Alaswad K, Rinfret S, Burke MN, Brilakis ES. Radial Versus Femoral Access in Chronic Total Occlusion Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2019; 12:e007778. [DOI: 10.1161/circinterventions.118.007778] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background:
Radial access (RA) is increasingly used in chronic total occlusion (CTO) percutaneous coronary intervention with encouraging results. However, there are concerns about its safety and efficacy because of higher complexity and the need for strong guide catheter support.
Methods and Results:
We performed a systematic review and meta-analysis of all studies published through November 2018 reporting the outcomes of RA versus femoral access in CTO percutaneous coronary intervention. Outcomes included major bleeding, access-site complications, in-hospital major adverse events, and technical success. Nine observational studies with 10 590 patients (10 617 lesions) were included in the meta-analysis. CTO lesions attempted using RA had lower Japan-CTO score (2.3±1.2 versus 2.5±1.3;
P
<0.001). Use of RA was associated with similar technical success (78.7% versus 78.5%; odds ratio, 1.11; 95% CI, 0.94–1.31;
P
=0.24;
I
2
=23%), lower risk of access-site complications (0.73% versus 1.79%; odds ratio, 0.34; 95% CI, 0.22–0.51;
P
<0.001;
I
2
=0%) and major bleeding (0.18% versus 0.9%; odds ratio, 0.22; 95% CI, 0.10–0.45;
P
<0.001;
I
2
=0%), and similar risk of in-hospital adverse events and in-hospital mortality (odds ratio, 0.36; 95% CI, 0.12–1.07;
P
=0.07;
I
2
=0%) as compared to femoral access. Results were similar when analyzing radial-only versus any femoral access and when excluding the largest study.
Conclusions:
As compared with femoral access, RA is used in CTO percutaneous coronary intervention of less complex lesions and is associated with fewer access-site complications and major bleeding and comparable technical success.
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Affiliation(s)
- Michael Megaly
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (M.M., J.J., M.N.B., E.S.B.)
- Division of Cardiovascular Medicine, Hennepin Healthcare, Minneapolis, MN (M.M.)
| | - Aris Karatasakis
- Department of Internal Medicine, Rutgers New Jersey Medical School, Newark (A.K.)
| | - Bishoy Abraham
- Department of Internal Medicine, Ascension St John Hospital, Detroit, MI (B.A.)
| | - Joseph Jensen
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (M.M., J.J., M.N.B., E.S.B.)
| | - Marwan Saad
- Division of Cardiology, Department of Medicine, University of Arkansas, Little Rock, (M.S.)
- Division of Cardiology, Ain Shams University, Cairo, Egypt (M.S.)
| | - Mohamed Omer
- University of Missouri Kansas City and Mid America Heart Institute (M.O.)
| | - Ayman Elbadawi
- Division of Cardiology, University of Texas Medical Branch, Galveston (A.E.)
| | - Yader Sandoval
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (Y.S.)
| | - Mehdi H. Shishehbor
- Division of Cardiology, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH (M.H.S.)
| | - Subhash Banerjee
- Veterans Affairs North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas (S.B.)
| | - Khaldoon Alaswad
- Division of Cardiology, Henry Ford Health System, Detroit, MI (K.A.)
| | - Stéphane Rinfret
- Division of Cardiology, McGill University Health Centre, Montreal, QC, Canada (S.R.)
| | - M. Nicholas Burke
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (M.M., J.J., M.N.B., E.S.B.)
| | - Emmanouil S. Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (M.M., J.J., M.N.B., E.S.B.)
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17
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Bakker EJ, Maeremans J, Zivelonghi C, Faurie B, Avran A, Walsh S, Spratt JC, Knaapen P, Hanratty CG, Bressollette E, Kayaert P, Bagnall AJ, Egred M, Smith D, McEntegart MB, Smith WH, Kelly P, Irving J, Smith EJ, Strange JW, Dens J, Agostoni P. Fully Transradial Versus Transfemoral Approach for Percutaneous Intervention of Coronary Chronic Total Occlusions Applying the Hybrid Algorithm. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.005255. [DOI: 10.1161/circinterventions.117.005255] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 07/17/2017] [Indexed: 11/16/2022]
Abstract
Background—
Small observational studies demonstrate the feasibility of transradial approach for chronic total occlusion (CTO) percutaneous coronary intervention. The aim of the current study is to assess technical success, complication rates, and procedural efficiency in fully transradial approach (fTRA) and transfemoral approach (TFA) in a large prospective European registry adopting the hybrid algorithm for CTO percutaneous coronary intervention (Registry of CrossBoss and Hybrid Procedures in France, the Netherlands, Belgium and United Kingdom, RECHARGE registry).
Methods and Results—
We analyzed 1253 CTO percutaneous coronary intervention procedures performed according to the hybrid protocol in 17 European centers, comparing fTRA (single or biradial access) and TFA (single or bifemoral or combined radial and femoral access). fTRA was applied in 306 (24%) and TFA in 947 (76%) cases. The average Japanese CTO score was 2.1±1.2 in fTRA and 2.3±1.1 in TFA (
P
=0.06). Technical success was achieved in 85% in fTRA and 86% in TFA (
P
=0.51). Technical success was comparable for fTRA and TFA in different Japanese CTO score subgroups after multivariable analysis and after propensity adjustment. In-hospital major adverse cardiac and cerebral events occurred in 2.0% in fTRA and 2.9% in TFA (
P
=0.40). Major access site bleeding occurred in 0.3% in fTRA and 0.5% in TFA (
P
=0.66). fTRA compared with TFA had similar procedural duration (80 minutes [54–120 minutes] versus 90 minutes [60–121 minutes];
P
=0.07), similar radiation dose (dose area product 89 Gray×cm
2
[52–163 Gray×cm
2
] versus 101 Gray×cm
2
[59–171 Gray×cm
2
];
P
=0.06), and lower contrast agent use (200 mL [150–310 mL] versus 250 mL [200–350 mL];
P
<0.01).
Conclusions—
fTRA CTO percutaneous coronary intervention is a valid alternative to TFA with a high rate of success, low complication rates, and no decrease in procedural efficiency.
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Affiliation(s)
- Erik Jan Bakker
- From the Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (E.J.B., C.Z., P.A.); Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (J.M., J.D.); Faculty of Medicine and Life Sciences, University of Hasselt, Belgium (J.M.); Department of Cardiology, Groupe Hospitalier Mutualiste, Grenoble, France (B.F.); Department of Cardiology, Clinique de Marignane, France (A.A.); Department of Cardiology, Arnault Tzanck Institut, St Laurent du Var, France (A.A.)
| | - Joren Maeremans
- From the Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (E.J.B., C.Z., P.A.); Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (J.M., J.D.); Faculty of Medicine and Life Sciences, University of Hasselt, Belgium (J.M.); Department of Cardiology, Groupe Hospitalier Mutualiste, Grenoble, France (B.F.); Department of Cardiology, Clinique de Marignane, France (A.A.); Department of Cardiology, Arnault Tzanck Institut, St Laurent du Var, France (A.A.)
| | - Carlo Zivelonghi
- From the Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (E.J.B., C.Z., P.A.); Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (J.M., J.D.); Faculty of Medicine and Life Sciences, University of Hasselt, Belgium (J.M.); Department of Cardiology, Groupe Hospitalier Mutualiste, Grenoble, France (B.F.); Department of Cardiology, Clinique de Marignane, France (A.A.); Department of Cardiology, Arnault Tzanck Institut, St Laurent du Var, France (A.A.)
| | - Benjamin Faurie
- From the Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (E.J.B., C.Z., P.A.); Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (J.M., J.D.); Faculty of Medicine and Life Sciences, University of Hasselt, Belgium (J.M.); Department of Cardiology, Groupe Hospitalier Mutualiste, Grenoble, France (B.F.); Department of Cardiology, Clinique de Marignane, France (A.A.); Department of Cardiology, Arnault Tzanck Institut, St Laurent du Var, France (A.A.)
| | - Alexandre Avran
- From the Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (E.J.B., C.Z., P.A.); Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (J.M., J.D.); Faculty of Medicine and Life Sciences, University of Hasselt, Belgium (J.M.); Department of Cardiology, Groupe Hospitalier Mutualiste, Grenoble, France (B.F.); Department of Cardiology, Clinique de Marignane, France (A.A.); Department of Cardiology, Arnault Tzanck Institut, St Laurent du Var, France (A.A.)
| | - Simon Walsh
- From the Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (E.J.B., C.Z., P.A.); Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (J.M., J.D.); Faculty of Medicine and Life Sciences, University of Hasselt, Belgium (J.M.); Department of Cardiology, Groupe Hospitalier Mutualiste, Grenoble, France (B.F.); Department of Cardiology, Clinique de Marignane, France (A.A.); Department of Cardiology, Arnault Tzanck Institut, St Laurent du Var, France (A.A.)
| | - James C. Spratt
- From the Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (E.J.B., C.Z., P.A.); Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (J.M., J.D.); Faculty of Medicine and Life Sciences, University of Hasselt, Belgium (J.M.); Department of Cardiology, Groupe Hospitalier Mutualiste, Grenoble, France (B.F.); Department of Cardiology, Clinique de Marignane, France (A.A.); Department of Cardiology, Arnault Tzanck Institut, St Laurent du Var, France (A.A.)
| | - Paul Knaapen
- From the Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (E.J.B., C.Z., P.A.); Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (J.M., J.D.); Faculty of Medicine and Life Sciences, University of Hasselt, Belgium (J.M.); Department of Cardiology, Groupe Hospitalier Mutualiste, Grenoble, France (B.F.); Department of Cardiology, Clinique de Marignane, France (A.A.); Department of Cardiology, Arnault Tzanck Institut, St Laurent du Var, France (A.A.)
| | - Colm G. Hanratty
- From the Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (E.J.B., C.Z., P.A.); Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (J.M., J.D.); Faculty of Medicine and Life Sciences, University of Hasselt, Belgium (J.M.); Department of Cardiology, Groupe Hospitalier Mutualiste, Grenoble, France (B.F.); Department of Cardiology, Clinique de Marignane, France (A.A.); Department of Cardiology, Arnault Tzanck Institut, St Laurent du Var, France (A.A.)
| | - Erwan Bressollette
- From the Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (E.J.B., C.Z., P.A.); Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (J.M., J.D.); Faculty of Medicine and Life Sciences, University of Hasselt, Belgium (J.M.); Department of Cardiology, Groupe Hospitalier Mutualiste, Grenoble, France (B.F.); Department of Cardiology, Clinique de Marignane, France (A.A.); Department of Cardiology, Arnault Tzanck Institut, St Laurent du Var, France (A.A.)
| | - Peter Kayaert
- From the Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (E.J.B., C.Z., P.A.); Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (J.M., J.D.); Faculty of Medicine and Life Sciences, University of Hasselt, Belgium (J.M.); Department of Cardiology, Groupe Hospitalier Mutualiste, Grenoble, France (B.F.); Department of Cardiology, Clinique de Marignane, France (A.A.); Department of Cardiology, Arnault Tzanck Institut, St Laurent du Var, France (A.A.)
| | - Alan J. Bagnall
- From the Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (E.J.B., C.Z., P.A.); Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (J.M., J.D.); Faculty of Medicine and Life Sciences, University of Hasselt, Belgium (J.M.); Department of Cardiology, Groupe Hospitalier Mutualiste, Grenoble, France (B.F.); Department of Cardiology, Clinique de Marignane, France (A.A.); Department of Cardiology, Arnault Tzanck Institut, St Laurent du Var, France (A.A.)
| | - Mohaned Egred
- From the Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (E.J.B., C.Z., P.A.); Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (J.M., J.D.); Faculty of Medicine and Life Sciences, University of Hasselt, Belgium (J.M.); Department of Cardiology, Groupe Hospitalier Mutualiste, Grenoble, France (B.F.); Department of Cardiology, Clinique de Marignane, France (A.A.); Department of Cardiology, Arnault Tzanck Institut, St Laurent du Var, France (A.A.)
| | - David Smith
- From the Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (E.J.B., C.Z., P.A.); Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (J.M., J.D.); Faculty of Medicine and Life Sciences, University of Hasselt, Belgium (J.M.); Department of Cardiology, Groupe Hospitalier Mutualiste, Grenoble, France (B.F.); Department of Cardiology, Clinique de Marignane, France (A.A.); Department of Cardiology, Arnault Tzanck Institut, St Laurent du Var, France (A.A.)
| | - Margaret B. McEntegart
- From the Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (E.J.B., C.Z., P.A.); Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (J.M., J.D.); Faculty of Medicine and Life Sciences, University of Hasselt, Belgium (J.M.); Department of Cardiology, Groupe Hospitalier Mutualiste, Grenoble, France (B.F.); Department of Cardiology, Clinique de Marignane, France (A.A.); Department of Cardiology, Arnault Tzanck Institut, St Laurent du Var, France (A.A.)
| | - William H.T. Smith
- From the Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (E.J.B., C.Z., P.A.); Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (J.M., J.D.); Faculty of Medicine and Life Sciences, University of Hasselt, Belgium (J.M.); Department of Cardiology, Groupe Hospitalier Mutualiste, Grenoble, France (B.F.); Department of Cardiology, Clinique de Marignane, France (A.A.); Department of Cardiology, Arnault Tzanck Institut, St Laurent du Var, France (A.A.)
| | - Paul Kelly
- From the Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (E.J.B., C.Z., P.A.); Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (J.M., J.D.); Faculty of Medicine and Life Sciences, University of Hasselt, Belgium (J.M.); Department of Cardiology, Groupe Hospitalier Mutualiste, Grenoble, France (B.F.); Department of Cardiology, Clinique de Marignane, France (A.A.); Department of Cardiology, Arnault Tzanck Institut, St Laurent du Var, France (A.A.)
| | - John Irving
- From the Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (E.J.B., C.Z., P.A.); Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (J.M., J.D.); Faculty of Medicine and Life Sciences, University of Hasselt, Belgium (J.M.); Department of Cardiology, Groupe Hospitalier Mutualiste, Grenoble, France (B.F.); Department of Cardiology, Clinique de Marignane, France (A.A.); Department of Cardiology, Arnault Tzanck Institut, St Laurent du Var, France (A.A.)
| | - Elliot J. Smith
- From the Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (E.J.B., C.Z., P.A.); Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (J.M., J.D.); Faculty of Medicine and Life Sciences, University of Hasselt, Belgium (J.M.); Department of Cardiology, Groupe Hospitalier Mutualiste, Grenoble, France (B.F.); Department of Cardiology, Clinique de Marignane, France (A.A.); Department of Cardiology, Arnault Tzanck Institut, St Laurent du Var, France (A.A.)
| | - Julian W. Strange
- From the Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (E.J.B., C.Z., P.A.); Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (J.M., J.D.); Faculty of Medicine and Life Sciences, University of Hasselt, Belgium (J.M.); Department of Cardiology, Groupe Hospitalier Mutualiste, Grenoble, France (B.F.); Department of Cardiology, Clinique de Marignane, France (A.A.); Department of Cardiology, Arnault Tzanck Institut, St Laurent du Var, France (A.A.)
| | - Joseph Dens
- From the Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (E.J.B., C.Z., P.A.); Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (J.M., J.D.); Faculty of Medicine and Life Sciences, University of Hasselt, Belgium (J.M.); Department of Cardiology, Groupe Hospitalier Mutualiste, Grenoble, France (B.F.); Department of Cardiology, Clinique de Marignane, France (A.A.); Department of Cardiology, Arnault Tzanck Institut, St Laurent du Var, France (A.A.)
| | - Pierfrancesco Agostoni
- From the Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (E.J.B., C.Z., P.A.); Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (J.M., J.D.); Faculty of Medicine and Life Sciences, University of Hasselt, Belgium (J.M.); Department of Cardiology, Groupe Hospitalier Mutualiste, Grenoble, France (B.F.); Department of Cardiology, Clinique de Marignane, France (A.A.); Department of Cardiology, Arnault Tzanck Institut, St Laurent du Var, France (A.A.)
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