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070 A comparison of the success rates of transradial and transfemoral approaches for percutaneous coronary intervention of chronic total occlusions
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文摘

Purpose

Chronic total occlusions (CTOs) are found in approximately 30 % of Pts with coronary artery disease and represent the most difficult group for treatment by percutaneous coronary intervention (PCI) with a lower angiographic success rate. Transradial PCI is safe and effective, though the efficacy of this approach in CTOs has not been well studied.

Methods

All Pts treated with PCI for CTOs between Jan 2004 and Dec 2009 were retrospectively identified from a dedicated database. We compared the success rates via the transradial (TRA) and transfemoral approach (TFA) with attention to the lesion characteristics and techniques applied.

Results

979 Pts (63.2 ¡À 11.6 years, 87.3 % male) were studied. Baseline demographics and angiographic characteristics were similar between groups with no difference in lesion length, calcification or proximal vessel tortuosity. There was a significant difference in the rate of bifurcations performed via the TRA and TFA (29.1 % vs. 14.6 % , p<0.0001). Parallel wire technique and retrograde recanalisation were used more frequently from the TFA. TRA was associated with an increased use of anchoring balloons.

Sheath sizes > 6 French were used in 20/979(2 % ). Larger sheath size was associated with a higher rate of parallel wire technique (p = 0.0004), retrograde recanalisation (p<0.0001) and tornus use (p = 0.027).

Conclusions

le class=""dataTable"" frame=""hsides"" border=""0"" cellpadding=""0"" rules=""groups"" cellspacing=""0"">
TFA (233 patients) TRA (646 patients) P value
left"">Sheath size ?6F218 (93.6 % )642 (99.4 % )<0.0001
left"">Sheath size ?8F11 (4.7 % )0 (0)<0.0001
left"">Parallel wire54 (23.2 % )106 (16.4 % )0.029
left"">Side branch technique7 (3.0 % )41 (6.3 % )0.06
left"">Anchoring balloon7 (3.0 % )48 (7.4 % )0.017
left"">Retrograde recanalisation16 (6.9 % )18 (2.8 % )0.009
left"">Procedural time73.4 +/?1.2min80.7+/?0.7min0.03
left"">Contrast use238.7mls +/?80.2mls286.2 +/?57.3mls0.001
left"">Angiographic Success139 (67.8 % )441 (70.7 % )0.44
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