title: Transradial approach for coronary chronic total occlusion interventions: Insights from a contemporary multicenter registry.
abstract: OBJECTIVE
  To examine the impact of transradial access on the procedural outcomes of chronic total occlusion (CTO) percutaneous coronary interventions (PCI).
  
  
  BACKGROUND
  The efficacy and safety of transradial access in CTO PCI has received limited study.
  
  
  METHODS
  We compared the technique and outcomes of transradial vs. transfemoral access among 650 CTO PCI cases performed between January 2012 and March 2014 at 6 US centers.
  
  
  RESULTS
  Most patients were men (87%) with high frequency of diabetes mellitus (42%) and prior coronary artery bypass graft surgery (36%). The CTO target vessel was the right coronary (59%), left anterior descending (20%), or circumflex (17%) artery. TR access was used in 110 (17%) of the 650 cases, as follows: bilateral radial access (63%); bilateral radial access plus unilateral or bilateral femoral access (7%); unilateral radial access plus unilateral or bilateral femoral access (26%); and unilateral radial access (4%). Six and eight French guide catheters were used through the radial and femoral artery, respectively. Compared to transfemoral, transradial cases had similar technical (92.6% vs. 93.0%, P = 0.87) and procedural (91.1% vs. 90.0%, P = 0.95) success and major complication rates (1.7% vs 1.8%, P = 0.99). However, transradial access was associated with higher mean procedure (142 ± 83 vs. 120 ± 60 min, P = 0.008) and fluoroscopy (58 ± 40 vs. 49 ± 31 min, P <0.026) time, and number of crossing approach changes (0.7 ± 1.0 vs. 0.5 ± 0.7, P = 0.008).
  
  
  CONCLUSIONS
  Transradial CTO PCI can be performed with similar success and complication rates with transfemoral CTO PCI, but is associated with longer procedural and fluoroscopy times. © 2015 Wiley Periodicals, Inc.
authors: Henry Ford Hospital, Detroit, Michigan.
authors: Khaldoon
authors: K
authors: Alaswad
authors: VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors: Rohan V
authors: RV
authors: Menon
authors: VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors: Georgios
authors: G
authors: Christopoulos
authors: St. Joseph Hospital, Bellingham, Washington.
authors: William L
authors: WL
authors: Lombardi
authors: Piedmont Hospital, Atlanta, Georgia.
authors: Dimitri
authors: D
authors: Karmpaliotis
authors: Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City, Missouri.
authors: J Aaron
authors: JA
authors: Grantham
authors: Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City, Missouri.
authors: Steven P
authors: SP
authors: Marso
authors: Torrance Memorial Center, Los Angeles, California.
authors: Michael R
authors: MR
authors: Wyman
authors: VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors: Nagendra R
authors: NR
authors: Pokala
authors: VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors: Siddharth M
authors: SM
authors: Patel
authors: VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors: Anna P
authors: AP
authors: Kotsia
authors: VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors: Bavana V
authors: BV
authors: Rangan
authors: Piedmont Hospital, Atlanta, Georgia.
authors: Nicholas
authors: N
authors: Lembo
authors: Piedmont Hospital, Atlanta, Georgia.
authors: David
authors: D
authors: Kandzari
authors: Piedmont Hospital, Atlanta, Georgia.
authors: James
authors: J
authors: Lee
authors: Piedmont Hospital, Atlanta, Georgia.
authors: Anna
authors: A
authors: Kalynych
authors: Piedmont Hospital, Atlanta, Georgia.
authors: Harold
authors: H
authors: Carlson
authors: Minneapolis VA Healthcare System and University of Minnesota, Minneapolis, Minnesota.
authors: Santiago A
authors: SA
authors: Garcia
authors: Boston Scientific, Natick, Massachusetts.
authors: Craig A
authors: CA
authors: Thompson
authors: VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors: Subhash
authors: S
authors: Banerjee
authors: VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors: Emmanouil S
authors: ES
authors: Brilakis
mesh_terms: D001026:Coronary Artery Bypass; D054059:Coronary Occlusion / Q000628:therapy*; D005260:Female; D005263:Femoral Artery; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D017534:Radial Artery; D012042:Registries
keywords: chronic total occlusion; percutaneous coronary intervention; radial access