Afety and Feasibility in Trans-radial Coronary Interventions for Chronic Total Occlusion

Abstract

Background and Objectives:Recent advances in trans-radial coronary intervention (TRI) have shown a reduction in patient’s morbidity. However, the role of TRI for a chronic total occlusion (CTO) is not well established. The aim of this study was to assess the safety and feasibility of TRI for a CTO. Subjects and Methods:Sixty-three successive CTO lesions of more than 2 months duration were prospectively included in this registry between April 2002 and November 2003. Guiding catheters with strong back-up, stiff guide wires and supportive infusion catheters were actively used. The angiographic and procedural characteristics were prospectively evaluated. Results:There were 45 male and 18 female patients, with a mean age of 59.8±9.5 years. The most common clinical diagnosis was stable angina (95.2%). The mean duration of the occlusions was 10.3±1.6 months. Procedural success was achieved in 53 lesions (84.1%). No cases were crossed over to transfemoral procedure. The most common cause of procedural failure was guide wire passage failure (7 lesions). The mean duration of occlusions was significantly longer in the failure group (7.5±1.1 versus 24.8± 6.5 months, p<0.001). Bridging collateral vessels, long occlusions, calcification at lesion sites, a side branch at the occlusion site and blunt entry morphology were also statistically significant predictors for procedural failure. Procedure-related complications were noted in 6 patients (9.8%), which included coronary perforations (3.3%), severe dissections (3.3%), arrhythmia (1.6%) and branch artery occlusion (1.6%). No patients suffered from local complications, such as hematoma or radial artery occlusion. Conclusion:TRI for a CTO seems to be safe and feasible, with acceptable success and complication rates. (Korean Circulation J 2004;34(8):767-774)