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The Evolving Role of Transradial Access in Chronic Total Occlusion Percutaneous Coronary Intervention

Published:January 06, 2023DOI:https://doi.org/10.1016/j.amjcard.2022.12.006
      Transradial access (TRA) has become the more popular approach for percutaneous coronary intervention (PCI) in non-chronic total occlusion (CTO) lesions owing to improved outcomes in both acute coronary syndrome
      • Romagnoli E
      • Biondi-Zoccai G
      • Sciahbasi A
      • Politi L
      • Rigattieri S
      • Pendenza G
      • Summaria F
      • Patrizi R
      • Borghi A
      • di Russo C
      • Moretti C
      • Agostoni P
      • Loschiavo P
      • Lioy E
      • Sheiban I
      • Sangiorgi G.
      Radial versus femoral randomized investigation in ST-segment elevation acute coronary syndrome: the RIFLE-STEACS (Radial Versus Femoral Randomized Investigation in ST-Elevation Acute Coronary Syndrome) study.
      ,
      • Valgimigli M
      • Gagnor A
      • Calabró P
      • Frigoli E
      • Leonardi S
      • Zaro T
      • Rubartelli P
      • Briguori C
      • Andò G
      • Repetto A
      • Limbruno U
      • Cortese B
      • Sganzerla P
      • Lupi A
      • Galli M
      • Colangelo S
      • Ierna S
      • Ausiello A
      • Presbitero P
      • Sardella G
      • Varbella F
      • Esposito G
      • Santarelli A
      • Tresoldi S
      • Nazzaro M
      • Zingarelli A
      • de Cesare N
      • Rigattieri S
      • Tosi P
      • Palmieri C
      • Brugaletta S
      • Rao SVv
      • Heg D
      • Rothenbühler M
      • Vranckx P
      • Jüni P
      MATRIX Investigators
      Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial.
      and stable ischemic heart disease.
      • Ferrante G
      • Rao SVv
      • Jüni P
      • da Costa BR
      • Reimers B
      • Condorelli G
      • Anzuini A
      • Jolly SS
      • Bertrand OF
      • Krucoff MW
      • Windecker S
      • Valgimigli M.
      Radial versus femoral access for coronary interventions across the entire spectrum of patients with coronary artery disease: a meta-analysis of randomized trials.
      ,
      • Feldman DN
      • Swaminathan RV
      • Kaltenbach LA
      • Baklanov DV
      • Kim LK
      • Wong SC
      • Minutello RM
      • Messenger JC
      • Moussa I
      • Garratt KN
      • Piana RN
      • Hillegass WB
      • Cohen MG
      • Gilchrist IC
      • Rao SV.
      Adoption of radial access and comparison of outcomes to femoral access in percutaneous coronary intervention: an updated report from the national cardiovascular data registry (2007–2012).
      The use of TRA in CTO PCI has increased significantly in the last decade owing to a multitude of factors that include increasing experience with transradial techniques, newer devices, and more appropriate patient selection.
      • Tajti P
      • Alaswad K
      • Karmpaliotis D
      • Jaffer FA
      • Yeh RW
      • Patel M
      • Mahmud E
      • Choi JW
      • Burke MN
      • Doing AH
      • Dattilo P
      • Toma C
      • Smith AJC
      • Uretsky BF
      • Holper E
      • Potluri S
      • Wyman RM
      • Kandzari DE
      • Garcia S
      • Krestyaninov O
      • Khelimskii D
      • Koutouzis M
      • Tsiafoutis I
      • Khatri JJ
      • Jaber W
      • Samady H
      • Jefferson B
      • Patel T
      • Abdullah S
      • Moses JW
      • Lembo NJ
      • Parikh M
      • Kirtane AJ
      • Ali ZA
      • Doshi D
      • Xenogiannis I
      • Stanberry LI
      • Rangan BVv
      • Ungi I
      • Banerjee S
      • Brilakis ES
      Procedural outcomes of percutaneous coronary interventions for chronic total occlusions via the radial approach: insights from an International chronic total occlusion registry.
      However, the use of TRA in CTO PCI remains a topic of debate.
      • Vadalà G
      • Galassi AR.
      Femoral versus radial artery access for CTO PCIs: is this the final round?.
      Several observational studies and 2 randomized controlled trials
      • Meijers TA
      • Aminian A
      • van Wely M
      • Teeuwen K
      • Schmitz T
      • Dirksen MT
      • Rathore S
      • van der Schaaf RJ
      • Knaapen P
      • Dens J
      • Iglesias JF
      • Agostoni P
      • Roolvink V
      • Hermanides RS
      • van Royen N
      • van Leeuwen MAH.
      Randomized comparison between radial and femoral large-bore access for complex percutaneous coronary intervention.
      ,
      • Gorgulu S
      • Kalay N
      • Norgaz T
      • Kocas C
      • Goktekin O
      • Brilakis ES.
      Femoral or radial approach in treatment of coronary chronic total occlusion: a randomized clinical trial.
      have compared TRA with transfemoral access (TFA) in CTO PCI and have demonstrated that TRA can achieve success rates comparable with TFA with a concomitant reduction in vascular complications. The randomized portion of this collective data is relatively modest in size, including 223 patients from the COLOR PCI (Complex Large-Bore Radial PCI) trial and 610 patients from the FORT CTO (Femoral or Radial Approach in the Treatment of Coronary CTO) trial.
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