A comparison of the transradial and the transfemoral approach in chronic total occlusion percutaneous coronary intervention

Abstract

The radial approach in CTO PCI is as fast and successful as the femoral approach with comparable in hospital MACE. However, there are far less access site complications with radial approach.

Comparison of fluoroscopy time during coronary angiography and interventions by radial and femoral routes- can we decrease the fluoroscopy time with increased experience? An observational study

“…It has been revealed in our study that fluoroscopy time can be minimized with increased experience particularly in r-CA where a significantly high difference in fluoroscopy use was noted among experienced and inexperienced groups. On the contrary, if we compare the fluoroscopy time of a well experienced femoral operator with a well experienced radial operator then it appears that well experienced radial operator (26) reported no significant difference in the length of fluoroscopy time when comparing TRA with TFA in patients who underwent PCI for chronic total occlusions. However, these studies were not designed to specifically evaluate the difference of radiation exposure with either route of access.…”

Impact of operator experience and wiring technique on procedural efficacy of trans-radial percutaneous chronic total occlusion recanalization performed by dedicated radialists

“…Our data suggest that in a dedicated TRA centre TRA can be considered also for highly complex PCI like CTO. The possible relevance of TRA experience in TRA CTO PCI is also suggested by the highly variable rate of access failure reported by previously published studies [5,[10][11][12][13]. Moreover, since access crossovers are mainly due to anatomical variants of radial and subclavian arteries [11], the ability to promptly recognize and appropriately overcome upper limb anatomic variants [14] is probably pivotal to successfully complete the procedure by TRA.…”

A Case Report on Percutaneous Coronary Intervention in Chronic Total Occlusion by Retrograde Visualization

“…and confirm the intraluminal position of the wire after the occluded segment. [5] Another important consideration is choosing the appropriate guide wires and its structural differences in terms of tip form,diameter,and coating.CTO's are frequently consists of a hard fibrotic cap proximally, loose fibrotic tissue with in the occlusion and a second hard fibrotic distally(second fibrotic cap most difficult to cross).In this scenario, stiff wires might be used to penetrate the proximal cap and distal cap.Floppy hydrophilic coated wires with low friction may be preferable to advance with in the occlusion. [6] A floppy wire is often the best initial choice to negotiate the segment proximal to the occlusion.…”