title: Is percutaneous coronary intervention of unprotected left main coronary artery via transradial approach feasible for skilled transfemoral operators? Initial experience in an unselected population.
abstract: BACKGROUND
  The feasibility and efficacy of percutaneous coronary intervention (PCI) of unprotected left main coronary artery (ULMCA) via transradial access (TRA) is still a matter of concern, mainly in an unselected population.
  
  
  METHODS
  We collected data about all PCI performed in patients with ULMCA stenosis by a TRA-dedicated operator and analyzed clinical and procedural characteristics as well as in-hospital and long-term outcomes.
  
  
  RESULTS
  From January 2008 to December 2011, 49 PCIs were performed; 27 (55%) via TRA and 22 (45%) via transfemoral access (TFA). Most patients in both groups underwent PCI for acute coronary syndrome (66.7% in the TRA group vs 77.3% in the TFA group, p=0.73). Patients in the TRA group were more hypertensive (81.5% vs 40.9%, p=0.008) and had a higher left ventricular ejection fraction (54.6±10.3 vs 46.1±12.8, p=0.01). There were no significant differences in procedural success (100% in the TRA group vs 90.9% in the TFA group, p=0.38), as well as in procedural time, in fluoroscopic time and in contrast volume. Bleeding complications occurred in 1 patient in the TFA group (4.5%) vs none in the TRA group (p=0.91). In-hospital major adverse cardiac events (MACE) occurred in 1 patient (3.7%) in the TRA group vs 3 (13.6%) in the TFA group (p=0.48). At a follow-up of 32±13 months, MACE occurred in 4 cases (14.8%) in the TRA group vs 7 cases (31.8%) in the TFA group (p=0.28).
  
  
  CONCLUSIONS
  The PCI of ULMCA via TRA is feasible with good results, provided that a rigorous learning curve was followed and a TRA volume caseload was maintained.
authors.affiliation: Department of Cardiology, Infermi Hospital, Rivoli, Italy. tomascard.tomassini@gmail.com
authors.forename: Francesco
authors.initials: F
authors.lastname: Tomassini
authors.forename: Andrea
authors.initials: A
authors.lastname: Gagnor
authors.forename: Nicolò
authors.initials: N
authors.lastname: Montali
authors.forename: Alfonso
authors.initials: A
authors.lastname: Gambino
authors.forename: Mario
authors.initials: M
authors.lastname: Bollati
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Infantino
authors.forename: Emanuele
authors.initials: E
authors.lastname: Tizzani
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Varbella
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography / Q000379:methods; D023921:Coronary Stenosis / Q000601:surgery; D003331:Coronary Vessels / Q000601:surgery*; D005260:Female; D006470:Hemorrhage / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D017534:Radial Artery / Q000601:surgery*; D016896:Treatment Outcome