Fully Transradial Versus Transfemoral Approach for Percutaneous Intervention of Coronary Chronic Total Occlusions Applying the Hybrid Algorithm Insights From RECHARGE Registry

被引：42

作者：

Bakker, Erik Jan ^{[1
]}

Maeremans, Joren ^{[2
,3
]}

Zivelonghi, Carlo ^{[1
]}

Faurie, Benjamin ^{[4
]}

Avran, Alexandre ^{[5
,6
]}

Walsh, Simon ^{[7
]}

Spratt, James C. ^{[8
]}

Knaapen, Paul ^{[9
]}

Hanratty, Colm G. ^{[7
]}

Bressollette, Erwan ^{[10
]}

Kayaert, Peter ^{[11
]}

Bagnall, Alan J. ^{[12
,13
]}

Egred, Mohaned ^{[12
,13
]}

Smith, David ^{[14
]}

McEntegart, Margaret B. ^{[15
]}

Smith, William H. T. ^{[16
]}

Kelly, Paul ^{[17
]}

Irving, John ^{[18
]}

Smith, Elliot J. ^{[19
]}

Strange, Julian W. ^{[20
]}

Dens, Joseph ^{[2
]}

Agostoni, Pierfrancesco ^{[1
]}

机构：

[1] St Antonius Hosp, Dept Cardiol, Koekoekslaan 1, NL-3435 CM Nieuwegein, Netherlands

[2] Ziekenhuis Oost Limburg, Dept Cardiol, Genk, Belgium

[3] Univ Hasselt, Fac Med & Life Sci, Hasselt, Belgium

[4] Grp Hosp Mutualiste, Dept Cardiol, Grenoble, France

[5] Clin Marignane, Dept Cardiol, Marignane, France

[6] Arnault Tzanck Inst, Dept Cardiol, St Laurent Du Var, France

[7] Belfast City Hosp, Dept Cardiol, Belfast, Antrim, North Ireland

[8] Forth Valley Royal Hosp, Dept Cardiol, Edinburgh, Midlothian, Scotland

[9] Vrije Univ Amsterdam, Med Ctr, Dept Cardiol, Amsterdam, Netherlands

[10] Nouvelles Clin Nantaises, Dept Cardiol, Nantes, France

[11] Univ Ziekenhuis Brussel, Dept Cardiol, Brussels, Belgium

[12] Freeman Rd Hosp, Dept Cardiol, Newcastle Upon Tyne, Tyne & Wear, England

[13] Newcastle Univ, Inst Cellular Med, Newcastle Upon Tyne, Tyne & Wear, England

[14] Morriston Hosp, Dept Cardiol, Swansea, W Glam, Wales

[15] Golden Jubilee Natl Hosp, Dept Cardiol, Glasgow, Lanark, Scotland

[16] Nottingham Univ Hosp, Dept Cardiol, Nottingham, England

[17] Basildon Hosp, Essex Cardiothorac Ctr, Dept Cardiol, Basildon, England

[18] Ninewells Hosp, Dept Cardiol, Dundee, Scotland

[19] Barts Hlth NHS Trust, Barts Heart Ctr, Dept Cardiol, London, England

[20] Bristol Heart Inst, Dept Cardiol, Bristol, Avon, England

来源：

CIRCULATION-CARDIOVASCULAR INTERVENTIONS | 2017年 / 10卷 / 09期

关键词：

coronary occlusion; percutaneous coronary intervention; prospective studies; radial artery; registries; RANDOMIZED-TRIALS; METAANALYSIS; MANAGEMENT; ARTERY; SCORE;

D O I：

10.1161/CIRCINTERVENTIONS.117.005255

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background-Small observational studies demonstrate the feasibility of transradial approach for chronic total occlusion (CTO) percutaneous coronary intervention. The aim of the current study is to assess technical success, complication rates, and procedural efficiency in fully transradial approach (fTRA) and transfemoral approach (TFA) in a large prospective European registry adopting the hybrid algorithm for CTO percutaneous coronary intervention (Registry of CrossBoss and Hybrid Procedures in France, the Netherlands, Belgium and United Kingdom, RECHARGE registry). Methods and Results-We analyzed 1253 CTO percutaneous coronary intervention procedures performed according to the hybrid protocol in 17 European centers, comparing fTRA (single or biradial access) and TFA (single or bifemoral or combined radial and femoral access). fTRA was applied in 306 (24%) and TFA in 947 (76%) cases. The average Japanese CTO score was 2.1 +/- 1.2 in fTRA and 2.3 +/- 1.1 in TFA (P=0.06). Technical success was achieved in 85% in fTRA and 86% in TFA (P=0.51). Technical success was comparable for fTRA and TFA in different Japanese CTO score subgroups after multivariable analysis and after propensity adjustment. In-hospital major adverse cardiac and cerebral events occurred in 2.0% in fTRA and 2.9% in TFA (P=0.40). Major access site bleeding occurred in 0.3% in fTRA and 0.5% in TFA (P=0.66). fTRA compared with TFA had similar procedural duration (80 minutes [54-120 minutes] versus 90 minutes [60-121 minutes]; P=0.07), similar radiation dose (dose area product 89 Grayxcm(2) [52-163 Grayxcm(2)] versus 101 Grayxcm(2) [59-171 Grayxcm(2)]; P=0.06), and lower contrast agent use (200 mL [150-310 mL] versus 250 mL [200-350 mL]; P<0.01). Conclusions-fTRA CTO percutaneous coronary intervention is a valid alternative to TFA with a high rate of success, low complication rates, and no decrease in procedural efficiency.

引用

页数：12

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