Feasibility of 5 Fr Contralateral Radial Access for Hybrid Chronic Total Occlusion Percutaneous Coronary Intervention: Experience From a Single Tertiary Center in the United Kingdom

Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) using the hybrid algorithm has traditionally been performed femorally using 8 Fr sheaths. Antegrade dissection and re-entry (ADR) has facilitated procedures using 6 and 7 Fr guides via the radial artery. Radial artery dysfunction and occlusion is a recognized complication preventing future radial procedures, but is significantly less common with 5 Fr sheaths. Five Fr contralateral radial access [48% left, 52% right) was used in 33 consecutive patients undergoing elective CTO-PCI in a single United Kingdom (UK) center over a 2-year period. Procedural data were recorded in the UK Hybrid CTO registry. Antegrade access was via contralateral radial in 26 cases and via femoral access in 5 cases. Single 5 Fr access was used in 2 cases treated by antegrade wire escalation. The mean J-CTO score was 2.1 1.2, with an overall success rate of 91%. A retrograde approach was used in 9 cases and ADR was used in 9 cases. The mean fluoroscopy and procedure times were 45.2 +/- 30.6 min and 172.5 +/- 118.1 min, respectively, and the mean volume of contrast use was 218.5 +/- 83.0 mL. There was 1 radial artery complication, 1 case of periprocedural myocardial infarction, and 1 case of tamponade. In this series, 5 Fr contralateral access provided adequate visualization in all cases. A 5 Fr guide provided adequate support in all retrograde cases to cross with a microcatheter after wire passage. Down-sizing contralateral access to 5 Fr routinely is feasible and may lead to a reduction in radial artery dysfunction and occlusion, as well as a reduction in the volume of contrast used.