Femoral or Radial Approach in Treatment of Coronary Chronic Total Occlusion: A Randomized Clinical Trial.

Abstract

The aim of this study was to compare transradial access (TRA) with transfemoral access (TFA) for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). TRA reduces the risk for vascular access complications but may make complex PCI, such as CTO PCI, more challenging. FORT CTO (Femoral or Radial Approach in the Treatment of Coronary Chronic Total Occlusion) (NCT03265769) was a prospective, noninferiority, randomized controlled study of TRA vs TFA for CTO PCI. The primary study endpoint was procedural success, defined as technical success without any in-hospital major adverse cardiovascular events. The secondary study endpoint was major access-site complications. Between 2017 and 2021, 610 of 800 patients referred for CTO PCI at 4 centers were randomized to TRA (n=305) or TFA (n=305). Mean J-CTO (Multicenter CTO Registry in Japan) (2.1 ± 0.1 vs 2.2 ± 0.1; P=0.279), PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) (1.3 ± 0.9 vs 1.1± 1.0; P=0.058) and PROGRESS CTO complication (2.4 ± 1.8 vs 2.3 ± 1.8; P=0.561) scores and use of the retrograde approach (11% vs 14%; P=0.342) were similar in the TRA and TFA groups. TRA was noninferior to TFAfor procedural success (84% vs 86%; P=0.563) but had fewer access-site complications (2.0% vs 5.6%; P=0.019). There was no difference between TFA and TRA in procedural duration, contrast volume, or radiation dose. TRA was noninferior to TFA for CTO PCI but had fewer access-site complications.