In the Journals

Transradial access reduces bleeding in CTO PCI

Compared with transfemoral access, transradial access was associated with less major bleeding and similar procedural outcomes in patients undergoing PCI for chronic total occlusions, according to new data from the PROGRESS CTO registry.

The researchers compared clinical, procedural and angiographic characteristics of 3,790 CTO interventions performed on patients (mean age, 65 years; 85% men) between 2012 and 2018 at 23 centers in the United States, Europe and Russia.

Among the procedures, 747 were performed with radial-only access, 844 were done with radial/femoral access and 2,199 were conducted with femoral-only access.

In 2012, only 11% of procedures were done with radial-only or radial/femoral access, but that figure had climbed to 67% by 2018 (P < .001), Peter Tajti, MD, interventional cardiology fellow at the Minneapolis Heart Institute, and colleagues wrote.

Compared with the other groups, patients who had radial-only access were younger (P < .001), less likely to have had prior CABG (P < .001) and less likely to have had prior PCI (P = .005), according to the researchers.

In addition, lesions in the radial-only group had lower J-CTO and PROGRESS CTO complication scores than lesions in the other groups (P < .001 for both).

Mean sheath size was smaller in the radial-only group (P < .0001) but increased in accordance with lesion complexity, Tajti and colleagues wrote.

Antegrade dissection re-entry was used less often in the radial-only group than in the other groups (P < .001), and retrograde techniques were used most frequently in the radial/femoral group, according to the researchers.

Technical success rates did not significantly differ between the groups (radial-only, 89%; radial/femoral, 88%; femoral only, 86%), nor did procedural success rates (radial-only, 86%; radial/femoral, 85%; femoral-only, 85%) or in-hospital major complications (radial-only, 2.47%; radial/femoral, 3.4%; femoral-only, 2.18%), the researchers found.

However, major bleeding risk was lower in the radial-only group than in the others (radial-only, 0.55%; radial/femoral, 1.94%; femoral-only, 0.88%; P = .013), Tajti and colleagues wrote.

In a related editorial, Salman A. Arain, MD, and H. Vernon Anderson, MD, both from the cardiology division, University of Texas Health Science Center, McGovern Medical School, Memorial Hermann Heart & Vascular Institute, Houston, wrote that the study “confirms that transradial CTO PCI is technically feasible and safe when patients are treated by experienced operators at higher-volume specialized centers. It also reaffirms the relative safety of radial compared with femoral access in terms of bleeding complications.”

The next step, they wrote, is to perform a large randomized trial to determine long-term clinical outcomes in CTO PCI. – by Erik Swain

Disclosures: Anderson and Tajti report no relevant financial disclosures. Arain reports he has spoken for St. Jude/Abbott and Teleflex. Please see the study for all other authors’ relevant financial disclosures.

Compared with transfemoral access, transradial access was associated with less major bleeding and similar procedural outcomes in patients undergoing PCI for chronic total occlusions, according to new data from the PROGRESS CTO registry.

The researchers compared clinical, procedural and angiographic characteristics of 3,790 CTO interventions performed on patients (mean age, 65 years; 85% men) between 2012 and 2018 at 23 centers in the United States, Europe and Russia.

Among the procedures, 747 were performed with radial-only access, 844 were done with radial/femoral access and 2,199 were conducted with femoral-only access.

In 2012, only 11% of procedures were done with radial-only or radial/femoral access, but that figure had climbed to 67% by 2018 (P < .001), Peter Tajti, MD, interventional cardiology fellow at the Minneapolis Heart Institute, and colleagues wrote.

Compared with the other groups, patients who had radial-only access were younger (P < .001), less likely to have had prior CABG (P < .001) and less likely to have had prior PCI (P = .005), according to the researchers.

In addition, lesions in the radial-only group had lower J-CTO and PROGRESS CTO complication scores than lesions in the other groups (P < .001 for both).

Mean sheath size was smaller in the radial-only group (P < .0001) but increased in accordance with lesion complexity, Tajti and colleagues wrote.

Antegrade dissection re-entry was used less often in the radial-only group than in the other groups (P < .001), and retrograde techniques were used most frequently in the radial/femoral group, according to the researchers.

Technical success rates did not significantly differ between the groups (radial-only, 89%; radial/femoral, 88%; femoral only, 86%), nor did procedural success rates (radial-only, 86%; radial/femoral, 85%; femoral-only, 85%) or in-hospital major complications (radial-only, 2.47%; radial/femoral, 3.4%; femoral-only, 2.18%), the researchers found.

However, major bleeding risk was lower in the radial-only group than in the others (radial-only, 0.55%; radial/femoral, 1.94%; femoral-only, 0.88%; P = .013), Tajti and colleagues wrote.

In a related editorial, Salman A. Arain, MD, and H. Vernon Anderson, MD, both from the cardiology division, University of Texas Health Science Center, McGovern Medical School, Memorial Hermann Heart & Vascular Institute, Houston, wrote that the study “confirms that transradial CTO PCI is technically feasible and safe when patients are treated by experienced operators at higher-volume specialized centers. It also reaffirms the relative safety of radial compared with femoral access in terms of bleeding complications.”

The next step, they wrote, is to perform a large randomized trial to determine long-term clinical outcomes in CTO PCI. – by Erik Swain

Disclosures: Anderson and Tajti report no relevant financial disclosures. Arain reports he has spoken for St. Jude/Abbott and Teleflex. Please see the study for all other authors’ relevant financial disclosures.