Chronic Total Occlusion
Feasibility and Safety of Chronic Total Occlusion Percutaneous Coronary Intervention via Distal Transradial Access in the Anatomical Snuffbox
Wei-Chieh Lee1, Shaur Zheng Chong1, Chiung-Jen Wu1
Kaohsiung Chang Gung Memorial Hospital, Taiwan1
Distal transradial access(dTRA) in the anatomical snuffbox is a challenging new access that brings considerable comfort to both the patient and operator, while also having a shorter time to hemostasis. However, few reports have assessed the impact of dTRA on complex chronic total occlusion (CTO) percutaneous coronary intervention (PCI). The current study aimed to verify the feasibility and safety of CTO-PCI via the dTRA in the anatomical snuffbox.
Between April 2017 and December 2019, 298 patients who underwent CTO PCI via dTRA were enrolled in this registry. The baseline demographic and procedural characteristics are listed, and the incidence of access-site vascular complications and procedural complications and mortality are reported.
The mean access time was 4.6 ± 2.9 min, and the mean procedure time was 115.9 ± 55.6 min. Left radial snuffbox access was performed successfully in 286 patients (96.5%), and right radial snuffbox access was performed successfully in 133 patients (97.7%). Bilateral radial snuffbox access was performed in 107 patients (35.9%). Two patients (0.7%) developed severe access-site vascular complications; one patient developed an arteriovenous fistula, and the other presented with severe forearm hematoma that required blood transfusion. None of the patients experienced severe radial artery spasm, and none of the patients developed radial artery occlusion during the follow-up period. The overall procedural success rate was 93.5%; 96.5% and87.7% in the groups that underwent the antegrade and retrograde approach, respectively.
It is both safe and feasible to use dTRA plus Glidesheath for complex CTO intervention. A low incidence of procedure-related complications and severe access-site vascular complications, and no incidences of radial artery occlusion were noted.