Radial Versus Femoral Access in Chronic Total Occlusion Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis

Michael Megaly, Aris Karatasakis, Bishoy Abraham, Joseph Jensen, Marwan Saad, Mohamed Omer, Ayman Elbadawi, Yader Sandoval, Mehdi H. Shishehbor, Subhash Banerjee, Khaldoon Alaswad, Stéphane Rinfret, M. Nicholas Burke, Emmanouil S. Brilakis

Research output: Contribution to journalArticlepeer-review

38 Scopus citations


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.

Original languageEnglish (US)
Article numbere007778
JournalCirculation: Cardiovascular Interventions
Issue number6
StatePublished - Jun 1 2019


  • chronic total occlusion
  • meta-analysis
  • percutaneous coronary intervention
  • radial access
  • risk

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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