Complex Chronic Total Occlusion Revascularization - A Comparison of Biradial Versus Femoral Access

• Published in: The Journal of invasive cardiology 2021-01, Vol.33 (1), p.E52
• Main Authors: Meah, Mohammed N, Ding, Wern Yew, Joseph, Tobin, Hasleton, Jonathan, Shaw, Matthew, Palmer, Nick D
• Format: Article
• Language: English
• Subjects: Chronic Disease; Coronary Angiography; Coronary Occlusion - diagnosis; Coronary Occlusion - surgery; Humans; Percutaneous Coronary Intervention - adverse effects; Registries; Retrospective Studies; Risk Factors; Treatment Outcome
• ISSN: 1557-2501; 1557-2501
• DOI: 10.25270/jic/20.00186

Complex chronic total occlusion (CTO) cases often require dual access. Evidence suggests that radial access is associated with lower success rates in complex CTOs. Our primary outcome was to determine efficacy of biradial access compared with femoral access. This was a retrospective, single-center, observational study. Patients who underwent dual-access CTO percutaneous coronary intervention (PCI) between January 2014 and January 2018 were enrolled. They were separated into biradial and femoral access groups. Data on demographics, comorbidities, complications, lesion characteristics, radiation, and contrast dose were collected. Standard univariate analyses were performed to identify predictors for revascularization failure. There were 150 cases identified, 109 biradial and 41 femoral access. There was no significant difference in success rate between the radial and femoral groups (87% vs 78%, respectively; P=.17). The average J-CTO score was 3 vs 4 (P=.04). Matched cohort analysis showed equivalent success rates (80.6% vs 75.0%, respectively; P=.53). Elevated body mass index, poor renal function, previous coronary artery bypass grafting, higher J-CTO, CTO >20 mm, presence of >45° bend within the diseased segment, and absence of collaterals were associated with CTO-PCI failure. Biradial access had shorter procedures (111 minutes vs 147 minutes; P