When and How to Perform a Transradial Approach for CTO PCI

Abstract

The radial artery (RA) access has been used to perform chronic total occlusion percutaneous coronary intervention (CTO PCI) with similar success and safety to CTO PCI using the common femoral artery (CFA) access. The success of a complex CTO PCI depends at the beginning on the use of two supportive guiding catheters with large enough lumen to accommodate multiple devices simultaneously. Two arterial accesses are needed in most CTO PCIs. Bilateral CFA accesses are frequently used to accommodate large bore supportive guiding catheters. Few CTO PCI operators combine one CFA access with one RA access to decrease potential bleeding complications from bilateral CFA accesses. However, operators from Canada and the United States have shown that CTO PCI using bilateral RA accesses have similar success rates and safety to CTO PCI from CFA accesses. They adapted all the current CTO PCI techniques to the 6 Fr guiding catheters from the RA access. They routinely perform antegrade dissection and re-entry (ADR) and retrograde techniques including controlled antegrade and retrograde tracking and reentry (CART) and reverse CART, using 6 Fr guiding catheters from bilateral RA accesses. More recently, techniques have been developed to use 7 or 8 Fr guiding catheters from the radial artery. This chapter describes the procedure of CTO PCI from bilateral RA accesses, and some of the difficulties encountered and their troubleshooting during these complex procedures.