TY - JOUR
T1 - Radial Versus Femoral Access in Chronic Total Occlusion Percutaneous Coronary Intervention
T2 - A Systematic Review and Meta-Analysis
AU - Megaly, Michael
AU - Karatasakis, Aris
AU - Abraham, Bishoy
AU - Jensen, Joseph
AU - Saad, Marwan
AU - Omer, Mohamed
AU - Elbadawi, Ayman
AU - Sandoval, Yader
AU - Shishehbor, Mehdi H.
AU - Banerjee, Subhash
AU - Alaswad, Khaldoon
AU - Rinfret, Stéphane
AU - Burke, M. Nicholas
AU - Brilakis, Emmanouil S.
N1 - Funding Information:
M.H. Shishehbor discloses education and consulting without compensation for Abbot Vascular, Medtronic, Covidien, Spectranetics, Cook, Terumo, and Boston Scientific. Dr Banerjee receives research grants from Boston Scientific and The Medicines Company; consultant/speaker honoraria from Gilead, St Jude, Cordis, Boehringer Ingelheim, Sanofi, and Medtronic; is a consultant to Covidien; and has ownership in MDCARE GLOBAL (spouse) and intellectual property in HygeiaTel. Dr Alaswad is a Consultant in Boston Scientific, Abbott Vascular, CSI, and LivaNova. Dr Rinfret is a Consultant in Boston Scientific, Abiomed, Abbott Vascular and Soundbite Medical. Dr Burke receives Consulting and speaker honoraria from Abbott Vascular and Boston Scientific. Dr Brilakis receives consulting/speaker honoraria from Abbott Vascular, American Heart Association (associate editor Circulation), Amgen, Boston Scientific, Cardiovascular Innovations Foundation (Board of Directors), CSI, Elsevier, GE Healthcare, and Medtronic; research support from Siemens, Regeneron, and Osprey. He is also a shareholder in MHI Ventures and a member of Board of Trustees in Society of Cardiovascular Angiography and Interventions. The other authors report no conflicts.
Publisher Copyright:
© 2019 American Heart Association, Inc.
PY - 2019/6/1
Y1 - 2019/6/1
N2 - Background: Radial access (RA) is increasingly used in chronic total occlusion (CTO) percutaneous coronary intervention with encouraging results. However, there are concerns about its safety and efficacy because of higher complexity and the need for strong guide catheter support. Methods and Results: We performed a systematic review and meta-analysis of all studies published through November 2018 reporting the outcomes of RA versus femoral access in CTO percutaneous coronary intervention. Outcomes included major bleeding, access-site complications, in-hospital major adverse events, and technical success. Nine observational studies with 10 590 patients (10 617 lesions) were included in the meta-analysis. CTO lesions attempted using RA had lower Japan-CTO score (2.3±1.2 versus 2.5±1.3; P<0.001). Use of RA was associated with similar technical success (78.7% versus 78.5%; odds ratio, 1.11; 95% CI, 0.94-1.31; P=0.24; I2=23%), lower risk of access-site complications (0.73% versus 1.79%; odds ratio, 0.34; 95% CI, 0.22-0.51; P<0.001; I2=0%) and major bleeding (0.18% versus 0.9%; odds ratio, 0.22; 95% CI, 0.10-0.45; P<0.001; I2=0%), and similar risk of in-hospital adverse events and in-hospital mortality (odds ratio, 0.36; 95% CI, 0.12-1.07; P=0.07; I2=0%) as compared to femoral access. Results were similar when analyzing radial-only versus any femoral access and when excluding the largest study. Conclusions: As compared with femoral access, RA is used in CTO percutaneous coronary intervention of less complex lesions and is associated with fewer access-site complications and major bleeding and comparable technical success.
AB - Background: Radial access (RA) is increasingly used in chronic total occlusion (CTO) percutaneous coronary intervention with encouraging results. However, there are concerns about its safety and efficacy because of higher complexity and the need for strong guide catheter support. Methods and Results: We performed a systematic review and meta-analysis of all studies published through November 2018 reporting the outcomes of RA versus femoral access in CTO percutaneous coronary intervention. Outcomes included major bleeding, access-site complications, in-hospital major adverse events, and technical success. Nine observational studies with 10 590 patients (10 617 lesions) were included in the meta-analysis. CTO lesions attempted using RA had lower Japan-CTO score (2.3±1.2 versus 2.5±1.3; P<0.001). Use of RA was associated with similar technical success (78.7% versus 78.5%; odds ratio, 1.11; 95% CI, 0.94-1.31; P=0.24; I2=23%), lower risk of access-site complications (0.73% versus 1.79%; odds ratio, 0.34; 95% CI, 0.22-0.51; P<0.001; I2=0%) and major bleeding (0.18% versus 0.9%; odds ratio, 0.22; 95% CI, 0.10-0.45; P<0.001; I2=0%), and similar risk of in-hospital adverse events and in-hospital mortality (odds ratio, 0.36; 95% CI, 0.12-1.07; P=0.07; I2=0%) as compared to femoral access. Results were similar when analyzing radial-only versus any femoral access and when excluding the largest study. Conclusions: As compared with femoral access, RA is used in CTO percutaneous coronary intervention of less complex lesions and is associated with fewer access-site complications and major bleeding and comparable technical success.
KW - chronic total occlusion
KW - meta-analysis
KW - percutaneous coronary intervention
KW - radial access
KW - risk
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UR - http://www.scopus.com/inward/citedby.url?scp=85068109009&partnerID=8YFLogxK
U2 - 10.1161/CIRCINTERVENTIONS.118.007778
DO - 10.1161/CIRCINTERVENTIONS.118.007778
M3 - Article
C2 - 31195826
AN - SCOPUS:85068109009
SN - 1941-7640
VL - 12
JO - Circulation: Cardiovascular Interventions
JF - Circulation: Cardiovascular Interventions
IS - 6
M1 - e007778
ER -