Immediate results of percutaneous coronary intervention for unprotected left main coronary artery stenoses: transradial versus transfemoral approach.
BACKGROUND
The effectiveness of a transradial approach for percutaneous coronary intervention (PCI) is comparable to that of a transfemoral approach. However, few studies have systematically compared the clinical effectiveness of a transradial approach with that of a transfemoral approach for unprotected left main coronary artery (ULMCA) stenoses. We compared success rate, vascular complications and early (in-hospital and six-month) outcomes of transradial PCI for ULMCA stenoses with those of a transfemoral approach.


METHODS
This retrospective study included 131 patients undergoing PCI for ULMCA stenoses between December 2000 and October 2006: 116 (88.5%) patients underwent a transradial approach and fifteen (11.5%) underwent a transfemoral approach.


RESULTS
Both angiographic and procedural success were achieved in 114 (98.3%) patients in the transradial group and fourteen (93.3%) patients in the transfemoral group (p = 0.876). Patients in the transfemoral group required more debulking procedures with large guiding catheters and had larger minimal luminal diameter following PCI than those in the transradial group. Transradial PCI produced fewer in-hospital major adverse cardiac events (MACE) (7.8% vs. 33.3%, p = 0.003) and a lower vascular complication rate compared to the transfemoral approach (1.7% vs. 26.6%, p < 0.001). Six-month MACE was lower in the transradial group than the transfemoral group without statistical significance (8.0% vs. 23.1%, p = 0.299).


CONCLUSIONS
A transradial approach for ULMCA diseases produced an equal success rate and a lower vascular complication rate when compared to a transfemoral approach. It should be considered as an acceptable alternative to the transfemoral approach for PCI in ULMCA diseases.
Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan, R.O.C.
Shu-Kai
SK
Hsueh
Yuan-Kai
YK
Hsieh
Chiung-Jen
CJ
Wu
Chih-Yuan
CY
Fang
Ali A
AA
Youssef
Chien-Jen
CJ
Chen
Shyh-Ming
SM
Chen
Cheng-Hsu
CH
Yang
Hon-Kan
HK
Yip
Mien-Cheng
MC
Chen
Morgan
M
Fu
Cheng-I
CI
Cheng
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods*; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000628:therapy*; D005260:Female; D005263:Femoral Artery; D006801:Humans; D008297:Male; D008875:Middle Aged; D017534:Radial Artery; D012189:Retrospective Studies; D016896:Treatment Outcome