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
1
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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.
J Am Coll Cardiol. 2012; 60: 2481-2489
2
and stable ischemic heart disease.
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MATRIX Investigators
Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial.
Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial.
Lancet. 2015; 385: 2465-2476
3
,- Ferrante G
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Radial versus femoral access for coronary interventions across the entire spectrum
of patients with coronary artery disease: a meta-analysis of randomized trials.
JACC Cardiovasc Interv. 2016; 9: 1419-1434
4
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.
- Feldman DN
- Swaminathan RV
- Kaltenbach LA
- Baklanov DV
- Kim LK
- Wong SC
- Minutello RM
- Messenger JC
- Moussa I
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- 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).
Circulation. 2013; 127: 2295-2306
5
However, the use of TRA in CTO PCI remains a topic of debate.
- 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
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- Ali ZA
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- Rangan BVv
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Procedural outcomes of percutaneous coronary interventions for chronic total occlusions
via the radial approach: insights from an International chronic total occlusion registry.
JACC Cardiovasc Interv. 2019; 12: 346-358
6
Several observational studies and 2 randomized controlled trials
7
,- 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
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- van Leeuwen MAH.
Randomized comparison between radial and femoral large-bore access for complex percutaneous
coronary intervention.
JACC Cardiovasc Interv. 2021; 14: 1293-1303
8
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.To read this article in full you will need to make a payment
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References
- 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.J Am Coll Cardiol. 2012; 60: 2481-2489
- Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial.Lancet. 2015; 385: 2465-2476
- Radial versus femoral access for coronary interventions across the entire spectrum of patients with coronary artery disease: a meta-analysis of randomized trials.JACC Cardiovasc Interv. 2016; 9: 1419-1434
- 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).Circulation. 2013; 127: 2295-2306
- Procedural outcomes of percutaneous coronary interventions for chronic total occlusions via the radial approach: insights from an International chronic total occlusion registry.JACC Cardiovasc Interv. 2019; 12: 346-358
- Femoral versus radial artery access for CTO PCIs: is this the final round?.JACC Cardiovasc Interv. 2022; 15: 831-833
- Randomized comparison between radial and femoral large-bore access for complex percutaneous coronary intervention.JACC Cardiovasc Interv. 2021; 14: 1293-1303
- Femoral or radial approach in treatment of coronary chronic total occlusion: a randomized clinical trial.JACC Cardiovasc Interv. 2022; 15: 823-830
- Influence of the ratio between radial artery inner diameter and sheath outer diameter on radial artery flow after transradial coronary intervention.Catheter Cardiovasc Interv. 1999; 46: 173-178
- Radial access for chronic total occlusion percutaneous coronary intervention: insights from the PROGRESS-CTO registry.Catheter Cardiovasc Interv. 2022; 100: 730-736
- Real-time ultrasound guidance facilitates femoral arterial access and reduces vascular complications: FAUST (Femoral Arterial Access With Ultrasound Trial).JACC Cardiovasc Interv. 2010; 3: 751-758
- Ultrasound guidance in femoral artery catheterization: a systematic review and a meta-analysis of randomized controlled trials.J Invasive Cardiol. 2019; 31: E192-E198
- Mechanical circulatory support in chronic total occlusion percutaneous coronary intervention: insights from a multicenter U.S. registry.J Invasive Cardiol. 2018; 30: 81-87
- Transradial coronary interventions for complex chronic total occlusions.JACC Cardiovasc Interv. 2017; 10: 235-243
- Complex chronic total occlusion revascularization - a comparison of biradial versus femoral access.J Invasive Cardiol. 2021; 33: E52-E58
Article info
Publication history
Published online: January 06, 2023
Received:
November 24,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Funding: None.
See page 2 for disclosure information.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
