Transradial Coronary Interventions for Complex Chronic Total Occlusions

OBJECTIVES The aims of this study were to assess whether the transradial approach can be applied to treat complex chronic total occlusion (CTO) and to determine the predictors of transradial percutaneous coronary intervention (PCI) failure. BACKGROUND Consistent data on the outcomes of transradial PCI for treating CTO are scarce. METHODS Consecutive patients who were not receiving hemodialysis and had undergone PCI for CTO were enrolled. The clinical and angiographic characteristics, procedural details, and outcomes of the transradial and transfemoral procedures were examined. RESULTS In total, 280 and 305 CTO PCI procedures involved transradial and transfemoral access, respectively. The technical success rates did not significantly differ in the entire cohort analysis and the propensity score-matched analysis (74.6% vs. 72.5%; p = 0.51 and 70.6% vs. 73.3%; p = 0.57). When only cases with J-CTO (Multicenter Chronic Total Occlusion Registry of Japan) scores of >= 3 were examined, the transradial group had a significantly lower success rate than the transfemoral group (35.7% vs. 58.2%; p = 0.04). The use of guiding catheter size <7 F (odds ratio [OR]: 5.50; p = 0.008), calcification (OR: 3.20; p = 0.001), occlusion length > 20 mm (OR: 2.97; p < 0.001), and age (OR: 1.04; p = 0.03) were associated with transradial CTO PCI failure. CONCLUSIONS Transradial PCI for CTO may be feasible in noncomplex cases, although complex cases still pose a challenge. In cases of transradial PCI for CTO, if possible, guiding catheter size >= 7 F should be selected regardless of lesion morphology. Furthermore, the transfemoral approach should be preferentially considered for complex CTO, particularly in cases with calcification. (C) 2017 by the American College of Cardiology Foundation.