Procedural Outcomes of Percutaneous Coronary Interventions for Chronic Total Occlusions Via the Radial Approach Insights From an International Chronic Total Occlusion Registry

被引：45

作者：

Tajti, Peter ^{[1
,2
,3
]}

Alaswad, Khaldoon ^{[4
]}

Karmpaliotis, Dimitri ^{[5
]}

Jaffer, Farouc A. ^{[6
]}

Yeh, Robert W. ^{[7
]}

Patel, Mitul ^{[8
,9
]}

Mahmud, Ehtisham ^{[8
,9
]}

Choi, James W. ^{[10
]}

Burke, M. Nicholas ^{[1
,2
]}

Doing, Anthony H. ^{[11
]}

Dattilo, Phil ^{[11
]}

Toma, Catalin ^{[12
]}

Smith, A. J. Conrad ^{[12
]}

Uretsky, Barry F. ^{[13
]}

Holper, Elizabeth ^{[14
]}

Potluri, Srinivasa ^{[14
]}

Wyman, R. Michael ^{[15
]}

Kandzari, David E. ^{[16
]}

Garcia, Santiago ^{[17
,18
]}

Krestyaninov, Oleg ^{[19
]}

Khelimskii, Dmitrii ^{[19
]}

Koutouzis, Michalis ^{[20
]}

Tsiafoutis, Ioannis ^{[20
]}

Khatri, Jaikirshan J. ^{[21
]}

Jaber, Wissam ^{[22
]}

Samady, Habib ^{[22
]}

Jefferson, Brian ^{[23
]}

Patel, Taral ^{[23
]}

Abdullah, Shuaib ^{[24
,25
]}

Moses, Jeffrey W. ^{[5
]}

Lembo, Nicholas J. ^{[5
]}

Parikh, Manish ^{[5
]}

Kirtane, Ajay J. ^{[5
]}

Ali, Ziad A. ^{[5
]}

Doshi, Darshan ^{[5
]}

Xenogiannis, Iosif ^{[1
,2
]}

Stanberry, Larissa I. ^{[1
,2
]}

Rangan, Bavana V. ^{[1
,2
]}

Ungi, Imre ^{[3
]}

Banerjee, Subhash ^{[24
,25
]}

Brilakis, Emmanouil S. ^{[1
,2
]}

机构：

[1] Abbott NW Hosp, Minneapolis Heart Inst, Minneapolis, MN USA

[2] Abbott NW Hosp, Minneapolis Heart Inst Fdn, Minneapolis, MN USA

[3] Univ Szeged, Dept Internal Med & Cardiol 2, Div Invas Cardiol, Szeged, Hungary

[4] Henry Ford Hosp, Detroit, MI 48202 USA

[5] Columbia Univ, New York, NY USA

[6] Massachusetts Gen Hosp, Boston, MA 02114 USA

[7] Beth Israel Deaconess Med Ctr, Boston, MA 02215 USA

[8] VA San Diego Healthcare Syst, La Jolla, CA USA

[9] Univ Calif San Diego, La Jolla, CA 92093 USA

[10] Baylor Heart & Vasc Hosp, Dallas, TX USA

[11] Med Ctr Rockies, Loveland, CO USA

[12] Univ Pittsburgh, Med Ctr, Pittsburgh, PA USA

[13] VA Cent Arkansas Healthcare Syst, Little Rock, AR USA

[14] Heart Hosp Baylor, Plano, TX USA

[15] Torrance Mem Med Ctr, Torrance, CA USA

[16] Piedmont Heart Inst, Atlanta, GA USA

[17] VA Minneapolis Healthcare Syst, Minneapolis, MN USA

[18] Univ Minnesota, Minneapolis, MN USA

[19] Minist Hlth Russian Federat, Meshalkin Siberian Fed Biomed Res Ctr, Novosibirsk, Russia

[20] Korgialeneio Benakeio Hellen Red Cross Gen Hosp, Athens, Greece

[21] Cleveland Clin, Cleveland, OH 44106 USA

[22] Emory Univ, Atlanta, GA 30322 USA

[23] Tristar Centennial Med Ctr, Nashville, TN USA

[24] VA North Texas Hlth Care Syst, Dallas, TX USA

[25] Univ Texas Southwestern Med Ctr Dallas, Dallas, TX 75390 USA

来源：

JACC-CARDIOVASCULAR INTERVENTIONS | 2019年 / 12卷 / 04期

关键词：

chronic total occlusion; outcomes; percutaneous coronary intervention; radial approach; ANGIOPLASTY; ALGORITHM; GUIDEWIRE; CATHETER; ACCESS;

D O I：

10.1016/j.jcin.2018.11.019

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

OBJECTIVES This study examined the frequency and outcomes of radial access for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). BACKGROUND Radial access improves the safety of PCI, but its role in CTO PCI remains controversial. METHODS We compared the clinical, angiographic, and procedural characteristics of 3,790 CTO interventions performed between 2012 and 2018 via radial-only access (RA) (n = 747) radial-femoral access (RFA) (n = 844) and femoralonly access (n = 2,199) access at 23 centers in the United States, Europe, and Russia. RESULTS Patients' mean age was 65 +/- 10 years, and 85% were men. Transradial access (RA and RFA) was used in 42% of CTO interventions and significantly increased over time from 11% in 2012 to 67% in 2018 (p < 0.001). RA patients were younger (age 62 +/- 10 years vs. 64 +/- 10 years and 65 +/- 10 years; p < 0.001), less likely to have undergone prior coronary artery bypass graft surgery (18% vs. 39% and 35%; p < 0.001), and less likely to have undergone prior PCI (60% vs. 63% and 66%; p = 0.005) compared with those who underwent RFA and femoral-only access PCI. RA CTO PCI lesions had lower J-CTO (Multicenter CTO Registry in Japan) (2.1 +/- 1.4 vs. 2.6 +/- 1.3 and 2.5 +/- 1.3; p < 0.001) and PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) complication (2.3 +/- 1.9 vs. 3.2 +/- 2.0 and 3.2 +/- 1.9; p < 0.001) scores. The mean sheath size was significantly smaller in the RA group (6.6 +/- 0.7 vs. 7.0 +/- 0.6 and 7.3 +/- 0.8; p < 0.0001), although it increased with lesion complexity. Antegrade dissection re-entry (20% vs. 33% and 32%; p < 0.001) was less commonly used with RA, whereas use of retrograde techniques was highest with RFA (47%). The overall rates of technical success (89% vs. 88% vs. 86%; p = 0.061), procedural success (86% vs. 85% vs. 85%; p = 0.528), and in-hospital major complication (2.47% vs. 3.40% vs. 2.18%; p = 0.830) were similar in all 3 groups, whereas major bleeding was lower in the RA group (0.55% vs. 1.94% and 0.88%; p = 0.013). CONCLUSIONS Transradial access is increasingly being used for CTO PCI and is associated with similar technical and procedural success and lower major bleeding rates compared with femoral-only access interventions. (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention [PROGRESS CTO]; NCT02061436) (J Am Coll Cardiol Intv 2019;12:346-58) (c) 2019 by the American College of Cardiology Foundation.

引用

页码：346 / 358

页数：13

共 28 条

[1] Transradial approach for coronary chronic total occlusion interventions: Insights from a contemporary multicenter registry [J].

Alaswad, Khaldoon ;

Menon, Rohan V. ;

Christopoulos, Georgios ;

Lombardi, William L. ;

Karmpaliotis, Dimitri ;

Grantham, J. Aaron ;

Marso, Steven P. ;

Wyman, Michael R. ;

Pokala, Nagendra R. ;

Patel, Siddharth M. ;

Kotsia, Anna P. ;

Rangan, Bavana V. ;

Lembo, Nicholas ;

Kandzari, David ;

Lee, James ;

Kalynych, Anna ;

Carlson, Harold ;

Garcia, Santiago A. ;

Thompson, Craig A. ;

Banerjee, Subhash ;

Brilakis, Emmanouil S. .

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, 2015, 85 (07) :1123-1129

[2] Adoption of the transradial approach for percutaneous coronary intervention and rates of vascular complications following transfemoral procedures: Insights from NCDR [J].

Badri, Marwan ;

Shapiro, Timothy ;

Wang, Yongfei ;

Minges, Karl E. ;

Curtis, Jeptha P. ;

Gray, William A. .

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, 2018, 92 (05) :835-841

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

Bakker, Erik Jan ;

Maeremans, Joren ;

Zivelonghi, Carlo ;

Faurie, Benjamin ;

Avran, Alexandre ;

Walsh, Simon ;

Spratt, James C. ;

Knaapen, Paul ;

Hanratty, Colm G. ;

Bressollette, Erwan ;

Kayaert, Peter ;

Bagnall, Alan J. ;

Egred, Mohaned ;

Smith, David ;

McEntegart, Margaret B. ;

Smith, William H. T. ;

Kelly, Paul ;

Irving, John ;

Smith, Elliot J. ;

Strange, Julian W. ;

Dens, Joseph ;

Agostoni, Pierfrancesco .

CIRCULATION-CARDIOVASCULAR INTERVENTIONS, 2017, 10 (09)

[4] A Percutaneous Treatment Algorithm for Crossing Coronary Chronic Total Occlusions [J].

Brilakis, Emmanouil S. ;

Grantham, J. Aaron ;

Rinfret, Stephane ;

Wyman, R. Michael ;

Burke, M. Nicholas ;

Karmpaliotis, Dimitri ;

Lembo, Nicholas ;

Pershad, Ashish ;

Kandzari, David E. ;

Buller, Christopher E. ;

DeMartini, Tony ;

Lombardi, William L. ;

Thompson, Craig A. .

JACC-CARDIOVASCULAR INTERVENTIONS, 2012, 5 (04) :367-379

[5] Radial Approach for Percutaneous Coronary Interventions on Chronic Total Occlusions: Technical Issues and Data Review [J].

Burzotta, Francesco ;

De Vita, Maria ;

Lefevre, Thierry ;

Tommasino, Antonella ;

Louvard, Yves ;

Trani, Carlo .

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, 2014, 83 (01) :47-57

[6] PERCUTANEOUS RADIAL ARTERY APPROACH FOR CORONARY ANGIOGRAPHY [J].

CAMPEAU, L .

CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS, 1989, 16 (01) :3-7

[7] GuideLiner, a child-in-a-mother catheter for successful retrieval of an entrapped rotablator burr [J].

Cunnington, Michael ;

Egred, Mohaned .

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, 2012, 79 (02) :271-273

[8] Development and Validation of a Scoring System for Predicting Periprocedural Complications During Percutaneous Coronary Interventions of Chronic Total Occlusions: The Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS CTO) Complications Score [J].

Danek, Barbara Anna ;

Karatasakis, Aris ;

Karmpaliotis, Dimitri ;

Alaswad, Khaldoon ;

Yeh, Robert W. ;

Jaffer, Farouc A. ;

Patel, Mitul P. ;

Mahmud, Ehtisham ;

Lombardi, William L. ;

Wyman, Michael R. ;

Grantham, J. Aaron ;

Doing, Anthony ;

Kandzari, David E. ;

Lembo, Nicholas J. ;

Garcia, Santiago ;

Toma, Catalin ;

Moses, Jeffrey W. ;

Kirtane, Ajay J. ;

Parikh, Manish A. ;

Ali, Ziad A. ;

Karacsonyi, Judit ;

Rangan, Bavana V. ;

Thompson, Craig A. ;

Banerjee, Subhash ;

Brilakis, Emmanouil S. .

JOURNAL OF THE AMERICAN HEART ASSOCIATION, 2016, 5 (10)

[9] Effectiveness and Safety of the Transradial 8Fr Sheathless Approach for Revascularization of Chronic Total Occlusions [J].

Dautov, Rustem ;

Ribeiro, Henrique Barbosa ;

Altisent, Omar Abdul-Jawad ;

Nombela-Franco, Luis ;

Gibrat, Claire ;

Can Manh Nguyen ;

Rinfret, Stephane .

AMERICAN JOURNAL OF CARDIOLOGY, 2016, 118 (06) :785-789

[10] Mother-Daughter-Granddaughter Double GuideLiner Technique for Delivering Stents Past Multiple Extreme Angulations [J].

Finn, Matthew T. ;

Green, Philip ;

Nicholson, William ;

Kalra, Sanjog ;

Kandzari, David E. ;

Lembo, Nicholas ;

Thompson, Craig A. ;

Karmpaliotis, Dimitri .

CIRCULATION-CARDIOVASCULAR INTERVENTIONS, 2016, 9 (08)

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