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The Efficacy and Feasibility of Chronic Total Occlusion by Transradial Intervention: A Japanese Single-Center Retrospective Study.

OBJECTIVES
To evaluate transradial intervention (TRI) for chronic total occlusion (CTO).


BACKGROUND
Although TRI has been applied to more complex lesions in percutaneous coronary intervention, efficacy and feasibility of TRI versus transfemoral intervention (TFI) for CTO have not yet been determined.


METHODS
We retrospectively analyzed 207 CTO lesions in 195 patients in a single center between January 2008 and December 2011. Patients were divided into four groups according to procedures: TRI (135 lesions in 124 patients); TFI (40 lesions in 39 patients); TRI/TFI (20 lesions in 20 patients); and TFI/TFI (12 lesions in 12 patients). Antegrade approach was used in TRI and TFI, but antegrade plus retrograde approach was used in TRI/TFI and TFI/TFI.


RESULTS
Although there were no differences in patient characteristics, complex CTO lesions such as blunt-type entry and retry lesions were frequently observed in the TFI/TFI group. Average sheath size was 5.7 Fr for TRI and 6.6 Fr for TFI. Fluoroscopy time was significantly longer for the antegrade plus retrograde approach. Procedure success rates were not statistically different: 82.2% in TRI, 72.5% in TFI, 75.0% in TRI/TFI, and 75.0% in TFI/TFI groups. There was no death, myocardial infarction, or stroke at 30 days in any groups. Two femoral cases and no radial cases had access-site complications. Access-site crossover from radial to femoral was conducted in 4 cases.


CONCLUSION
More than one-half of CTO lesions can be treated with high success and low complication rates by TRI if the lesions are carefully selected.