Access Site Selection and Outcomes for Chronic Total Occlusion Percutaneous Coronary Interventions: Insights from the VA CART Program

There has been increasing use of transradial access (TRA) for non–chronic total occlusion (CTO) percutaneous coronary intervention (PCI). There are limited data on TRA for CTO PCI. The objectives of this study were to assess the temporal trends in the use of TRA versus transfemoral access (TFA), ide...

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Bibliographic Details
Published in:Journal of the Society for Cardiovascular Angiography & Interventions 2022-11, Vol.1 (6), p.100440, Article 100440
Main Authors: Chakravartti, Jaidip, Feser, William J., Plomondon, Mary E., Valle, Javier A., Rao, Sunil V., Gutierrez, J. Antonio, Grunwald, Gary K., Gunzburger, Elise, Swaminathan, Rajesh V.
Format: Article
Language:English
Subjects:
chronic total occlusion
percutaneous coronary intervention
transfemoral
transradial
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Summary:There has been increasing use of transradial access (TRA) for non–chronic total occlusion (CTO) percutaneous coronary intervention (PCI). There are limited data on TRA for CTO PCI. The objectives of this study were to assess the temporal trends in the use of TRA versus transfemoral access (TFA), identify procedural and lesion characteristics associated with the use of TRA and TFA, and evaluate the association of access site with procedural complications and technical success among veterans undergoing attempted CTO PCI. We performed a retrospective analysis of veteran patients who underwent attempted CTO PCI to compare outcomes between TRA and TFA. Patients who had undergone attempted PCI of at least 1 CTO were included. Propensity score matching was used to evaluate the composite primary outcome of major procedural complications, in-hospital bleeding, or 30-day mortality and the secondary outcome of procedural success. In total, 4609 patients underwent attempted CTO PCI during 2010-2017. Rates of TRA for CTO PCI increased significantly, from 7% in 2010 to 38% in 2017 (Ptrend < .01). A greater percentage of CTO lesions in the TFA group was calcified and >20.0 mm in length. TRA was not associated with a reduction in the composite primary outcome (TRA 3.3% vs TFA 4.0%, P = .47) or procedural success (TRA 66.6% vs TFA 65.7%, P = .74) compared with TFA. In this retrospective analysis of patients who underwent attempted CTO PCI, the proportion of TRA for CTO PCI has increased over time but was not associated with a greater safety or procedural success than TFA. [Display omitted] •Retrospective study of veterans who had intervention for chronic total occlusion.•Increased use of transradial access over the study period.•Similar safety and technical success rates for transradial and transfemoral access.
ISSN:2772-9303
2772-9303
DOI:10.1016/j.jscai.2022.100440