The transradial (TR) access is the preferred approach in patients who undergo percutaneous
coronary intervention (PCI) because it has a better safety profile and mortality benefit
than the transfemoral (TF) approach.
1
The 2021 American College of Cardiology/American Heart Association joint committee
recommends the TR approach over the TF for PCI in acute coronary syndrome and stable
ischemic heart disease to reduce mortality and complications (Class I recommendation).
- Lawton JS
- Tamis-Holland JE
- Bangalore S
- Bates ER
- Beckie TM
- Bischoff JM
- Bittl JA
- Cohen MG
- Dimaio JM
- Don CW
- Fremes SE
- Gaudino MF
- Goldberger ZD
- Grant MC
- Jaswal JB
- Kurlansky PA
- Mehran R
- Metkus TS
- Nnacheta LC
- Rao SV v.
- Sellke FW
- Sharma G
- Yong CM
- Zwischenberger BA.
2021 ACC/AHA/SCAI guideline for coronary artery revascularization: a report of the
American College of Cardiology/American Heart Association joint committee on clinical
practice guidelines.
Circulation. 2022; 145: e18-e114
1
However, complex PCI including chronic coronary total occlusion (CTO) has technical
difficulties that might require the use of a large-bore femoral guide wire. Furthermore,
studies in patients who underwent PCI for CTO have been very limited and under-represented
in the literature. Observational studies have reported a higher success rate and lower
access site complications in the TR than in the TF approach in CTO.
- Lawton JS
- Tamis-Holland JE
- Bangalore S
- Bates ER
- Beckie TM
- Bischoff JM
- Bittl JA
- Cohen MG
- Dimaio JM
- Don CW
- Fremes SE
- Gaudino MF
- Goldberger ZD
- Grant MC
- Jaswal JB
- Kurlansky PA
- Mehran R
- Metkus TS
- Nnacheta LC
- Rao SV v.
- Sellke FW
- Sharma G
- Yong CM
- Zwischenberger BA.
2021 ACC/AHA/SCAI guideline for coronary artery revascularization: a report of the
American College of Cardiology/American Heart Association joint committee on clinical
practice guidelines.
Circulation. 2022; 145: e18-e114
2
,- Soud M
- SayedAhmad Z
- Kajy M
- Alahdab F
- Darmoch F
- Al-Khadra Y
- Pacha HM
- Sattar Y
- Ullah W
- King F
- Saad AB
- Alhatemi G
- Hakim Z
- Ali OE
- Glazier JJ
- Alraies MC.
The efficacy and safety of transradial and transfemoral approach in treatment of coronary
chronic total occlusion: a systematic review and meta-analysis.
Expert Rev Cardiovasc Ther. 2020; 18: 809-817
3
Recently, 2 randomized controlled trials (RCTs) compared the outcomes of the TR and
TF approaches in complex and CTO PCI.
4
,- Meijers TA
- Aminian A
- van Wely M
- Teeuwen K
- Schmitz T
- Dirksen MT
- Rathore S
- Schaaf RJ van der
- Knaapen P
- Dens J
- Iglesias JF
- Agostoni P
- Roolvink V
- Hermanides RS
- Royen N van
- Leeuwen MAH van
Randomized comparison between radial and femoral large-bore access for complex percutaneous
coronary intervention.
JACC Cardiovasc Intv. 2021; 14: 1293-1303
5
We conducted a meta-analysis, including the latest results from the RCTs, that compared
the TR with the TF approach in CTO PCI.To read this article in full you will need to make a payment
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References
- 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines.Circulation. 2022; 145: e18-e114
- The efficacy and safety of transradial and transfemoral approach in treatment of coronary chronic total occlusion: a systematic review and meta-analysis.Expert Rev Cardiovasc Ther. 2020; 18: 809-817
- Radial versus femoral access in chronic total occlusion percutaneous coronary intervention.Circ Cardiovasc Interv. 2019; 12e007778
- Randomized comparison between radial and femoral large-bore access for complex percutaneous coronary intervention.JACC Cardiovasc Intv. 2021; 14: 1293-1303
- Femoral or radial approach in treatment of coronary chronic total occlusion: a randomized clinical trial.JACC Cardiovasc Intv. 2022; 15: 823-830
- Complex Large-Bore Radial percutaneous coronary intervention: rationale of the COLOR trial study protocol.BMJ Open. 2020; 10e038042
Article Info
Publication History
Published online: July 15, 2022
Received:
May 25,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
