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

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,...

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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
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Ding, Wern Yew
Joseph, Tobin
Hasleton, Jonathan
Shaw, Matthew
Palmer, Nick D
description 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
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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 &gt;20 mm, presence of &gt;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&lt;.01), reduced radiation exposure (dose-area product, 17,452 cGy•cm² vs 23,651 cGy•cm²; P&lt;.01), less contrast (237 mL vs 315 mL; P=.11) and reduced hospital stay (0.38 ± 1.3 days vs 0.61 ± 1.1 days; P=.02). With shorter length of stay, fewer complications, and less radiation used in radial cases, we suggest biradial access is an effective and safe alternative in CTO-PCI. Prospective studies are needed to determine superiority.</description><identifier>ISSN: 1557-2501</identifier><identifier>EISSN: 1557-2501</identifier><identifier>DOI: 10.25270/jic/20.00186</identifier><identifier>PMID: 33385987</identifier><language>eng</language><publisher>United States</publisher><subject>Chronic Disease ; Coronary Angiography ; Coronary Occlusion - diagnosis ; Coronary Occlusion - surgery ; Humans ; Percutaneous Coronary Intervention - adverse effects ; Registries ; Retrospective Studies ; Risk Factors ; Treatment Outcome</subject><ispartof>The Journal of invasive cardiology, 2021-01, Vol.33 (1), p.E52</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27922,27923</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33385987$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Meah, Mohammed N</creatorcontrib><creatorcontrib>Ding, Wern Yew</creatorcontrib><creatorcontrib>Joseph, Tobin</creatorcontrib><creatorcontrib>Hasleton, Jonathan</creatorcontrib><creatorcontrib>Shaw, Matthew</creatorcontrib><creatorcontrib>Palmer, Nick D</creatorcontrib><title>Complex Chronic Total Occlusion Revascularization - A Comparison of Biradial Versus Femoral Access</title><title>The Journal of invasive cardiology</title><addtitle>J Invasive Cardiol</addtitle><description>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 &gt;20 mm, presence of &gt;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&lt;.01), reduced radiation exposure (dose-area product, 17,452 cGy•cm² vs 23,651 cGy•cm²; P&lt;.01), less contrast (237 mL vs 315 mL; P=.11) and reduced hospital stay (0.38 ± 1.3 days vs 0.61 ± 1.1 days; P=.02). With shorter length of stay, fewer complications, and less radiation used in radial cases, we suggest biradial access is an effective and safe alternative in CTO-PCI. 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subjects Chronic Disease
Coronary Angiography
Coronary Occlusion - diagnosis
Coronary Occlusion - surgery
Humans
Percutaneous Coronary Intervention - adverse effects
Registries
Retrospective Studies
Risk Factors
Treatment Outcome
title Complex Chronic Total Occlusion Revascularization - A Comparison of Biradial Versus Femoral Access
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