AS-239: Feasibility and Safety of a Transradial Approach in Angioplasty for Chronic Total Occlusion in the Coronary Artery: A Single-Center Experience

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.…”

Radial approach for percutaneous coronary interventions on chronic total occlusions: Technical issues and data review

“…Studies published in extenso within November 2012 on TRA for CTO were identified by Medline search (http://www.ncbi.nlm.nih.gov) entering the words “chronic total occlusion” or “CTO” and “radial approach” or “transradial”. Furthermore, the TCT (http://www.tctmd.com), EuroPCR (http://www.europcr.com), ESC (http://www.escardio.org), SCAI (http://www.scai.org) and AHA (http://www.americanheart.org) websites were searched for pertinent abstracts and expert slides presentations . Case reports and case series with less than 10 CTO lesions were excluded.…”

“…No prospective randomized trial was found, whereas 13 observational studies provided data regarding 3,501 PCI for CTOs by TRA . Of these, seven studies were published as full papers, whereas six studies were available as abstract or expert slide presentation . One study, firstly published as an abstract, has been recently accepted for publication as a full paper .…”

“…Of note, all studies were single centre and were conducted by operators reporting to have a specific experience in TRA PCI. The majority of the studies adopted mainly the antegrade technique (Table ), whereas two registries reported respectively a single centre and a single operator experience with retrograde bi‐radial technique (Table ).…”

“…Three studies only reported the criteria used to exclude patients from TRA and these were: Negative Allen's (and or Barbeau) test for both wrists and chronic renal failure requiring dialysis. Eight studies reported the rate of femoral access or brachial access use during the study period and this ranged between 4.5 and 42%. The reasons for exclusion from radial artery access reported in four (out of such eight) studies were: Discretion of the individual operator , radial artery too small for a 6‐Fr introducer, negative Allen's test, absent or weak radial pulse, haemodialysis .…”