Transradial Coronary Interventions for Complex Chronic Total Occlusions.
The aims of this study were to assess whether the transradial approach can be applied to treat complex chronic total occlusion (CTO) and to determine the predictors of transradial percutaneous coronary intervention (PCI) failure.



Consistent data on the outcomes of transradial PCI for treating CTO are scarce.



Consecutive patients who were not receiving hemodialysis and had undergone PCI for CTO were enrolled. The clinical and angiographic characteristics, procedural details, and outcomes of the transradial and transfemoral procedures were examined.



In total, 280 and 305 CTO PCI procedures involved transradial and transfemoral access, respectively. The technical success rates did not significantly differ in the entire cohort analysis and the propensity score-matched analysis (74.6% vs. 72.5%; p = 0.51 and 70.6% vs. 73.3%; p = 0.57). When only cases with J-CTO (Multicenter Chronic Total Occlusion Registry of Japan) scores of ≥3 were examined, the transradial group had a significantly lower success rate than the transfemoral group (35.7% vs. 58.2%; p = 0.04). The use of guiding catheter size <7 F (odds ratio [OR]: 5.50; p = 0.008), calcification (OR: 3.20; p = 0.001), occlusion length >20 mm (OR: 2.97; p < 0.001), and age (OR: 1.04; p = 0.03) were associated with transradial CTO PCI failure.



Transradial PCI for CTO may be feasible in noncomplex cases, although complex cases still pose a challenge. In cases of transradial PCI for CTO, if possible, guiding catheter size ≥7 F should be selected regardless of lesion morphology. Furthermore, the transfemoral approach should be preferentially considered for complex CTO, particularly in cases with calcification.
Department of Cardiology and Catheterization Laboratory, Shonan Kamakura General Hospital, Kamakura, Japan. Electronic address: yutakatanaka_circ@yahoo.co.jp.
Yutaka
Y
Tanaka
Department of Cardiology and Catheterization Laboratory, Shonan Kamakura General Hospital, Kamakura, Japan.
Noriaki
N
Moriyama
Department of Cardiology and Catheterization Laboratory, Shonan Kamakura General Hospital, Kamakura, Japan.
Tomoki
T
Ochiai
Department of Cardiology and Catheterization Laboratory, Shonan Kamakura General Hospital, Kamakura, Japan.
Takuma
T
Takada
Department of Cardiology and Catheterization Laboratory, Shonan Kamakura General Hospital, Kamakura, Japan.
Kazuki
K
Tobita
Department of Cardiology and Catheterization Laboratory, Shonan Kamakura General Hospital, Kamakura, Japan.
Koki
K
Shishido
Department of Cardiology and Catheterization Laboratory, Shonan Kamakura General Hospital, Kamakura, Japan.
Kazuya
K
Sugitatsu
Department of Cardiology and Catheterization Laboratory, Shonan Kamakura General Hospital, Kamakura, Japan.
Futoshi
F
Yamanaka
Department of Cardiology and Catheterization Laboratory, Shonan Kamakura General Hospital, Kamakura, Japan.
Shingo
S
Mizuno
Department of Cardiology and Catheterization Laboratory, Shonan Kamakura General Hospital, Kamakura, Japan.
Masato
M
Murakami
Department of Cardiology and Catheterization Laboratory, Shonan Kamakura General Hospital, Kamakura, Japan.
Junya
J
Matsumi
Department of Cardiology and Catheterization Laboratory, Shonan Kamakura General Hospital, Kamakura, Japan.
Saeko
S
Takahashi
Department of Cardiology and Catheterization Laboratory, Shonan Kamakura General Hospital, Kamakura, Japan.
Takeshi
T
Akasaka
Department of Cardiology and Catheterization Laboratory, Shonan Kamakura General Hospital, Kamakura, Japan.
Shigeru
S
Saito
D000368:Aged; D062906:Cardiac Catheters; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D016009:Chi-Square Distribution; D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000628:therapy*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D057216:Propensity Score; D017534:Radial Artery / Q000000981:diagnostic imaging; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
angioplasty; coronary disease; occlusion