Meta-analysis Comparing Transradial With Transfemoral Access in the Treatment of Coronary Chronic Total Occlusion

Abstract

The transradial (TR) access is the preferred approach in patients who undergo percutaneous coronary intervention (PCI) because it has a better safety profile and mortality benefit than the transfemoral (TF) approach. 1 Lawton JS Tamis-Holland JE Bangalore S Bates ER Beckie TM Bischoff JM Bittl JA Cohen MG Dimaio JM Don CW Fremes SE Gaudino MF Goldberger ZD Grant MC Jaswal JB Kurlansky PA Mehran R Metkus TS Nnacheta LC Rao SV v. Sellke FW Sharma G Yong CM Zwischenberger BA. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. Circulation. 2022; 145: e18-e114 Google Scholar The 2021 American College of Cardiology/American Heart Association joint committee recommends the TR approach over the TF for PCI in acute coronary syndrome and stable ischemic heart disease to reduce mortality and complications (Class I recommendation). 1 Lawton JS Tamis-Holland JE Bangalore S Bates ER Beckie TM Bischoff JM Bittl JA Cohen MG Dimaio JM Don CW Fremes SE Gaudino MF Goldberger ZD Grant MC Jaswal JB Kurlansky PA Mehran R Metkus TS Nnacheta LC Rao SV v. Sellke FW Sharma G Yong CM Zwischenberger BA. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. Circulation. 2022; 145: e18-e114 Google Scholar However, complex PCI including chronic coronary total occlusion (CTO) has technical difficulties that might require the use of a large-bore femoral guide wire. Furthermore, studies in patients who underwent PCI for CTO have been very limited and under-represented in the literature. Observational studies have reported a higher success rate and lower access site complications in the TR than in the TF approach in CTO. 2 Soud M SayedAhmad Z Kajy M Alahdab F Darmoch F Al-Khadra Y Pacha HM Sattar Y Ullah W King F Saad AB Alhatemi G Hakim Z Ali OE Glazier JJ Alraies MC. The efficacy and safety of transradial and transfemoral approach in treatment of coronary chronic total occlusion: a systematic review and meta-analysis. Expert Rev Cardiovasc Ther. 2020; 18: 809-817 Google Scholar ,3 Megaly M Karatasakis A Abraham B Jensen J Saad M Omer M Elbadawi A Sandoval Y Shishehbor MH Banerjee S Alaswad K Rinfret S Burke MN Brilakis ES. Radial versus femoral access in chronic total occlusion percutaneous coronary intervention. Circ Cardiovasc Interv. 2019; 12e007778 Google Scholar Recently, 2 randomized controlled trials (RCTs) compared the outcomes of the TR and TF approaches in complex and CTO PCI. 4 Meijers TA Aminian A van Wely M Teeuwen K Schmitz T Dirksen MT Rathore S Schaaf RJ van der Knaapen P Dens J Iglesias JF Agostoni P Roolvink V Hermanides RS Royen N van Leeuwen MAH van Randomized comparison between radial and femoral large-bore access for complex percutaneous coronary intervention. JACC Cardiovasc Intv. 2021; 14: 1293-1303 Google Scholar ,5 Gorgulu S Kalay N Norgaz T Kocas C Goktekin O Brilakis ES. Femoral or radial approach in treatment of coronary chronic total occlusion: a randomized clinical trial. JACC Cardiovasc Intv. 2022; 15: 823-830 Google Scholar We conducted a meta-analysis, including the latest results from the RCTs, that compared the TR with the TF approach in CTO PCI.