Meta-Analysis on the Safety and Efficacy of Transradial Approach in Chronic Total Occlusion Percutaneous Coronary Intervention
Graphical Abstract
CABG = coronary artery bypass graft; OS = observational studies; RCTs = randomized controlled trials.
Section snippets
Methods
We performed an electronic search using PubMed, Embase, Web of Science, ClinicalTrials.gov, and Cochrane databases from inception to July 2022 without language restrictions. Search terms and the number of results per database are shown in Supplementary Method 1. The reference lists of the retrieved studies were screened for any additional studies not identified with the initial search. This work was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and
Results
Our search strategy retrieved 1,867 references; the study selection process is summarized in Figure 1. Nineteen studies were selected for inclusion, containing 2 cohorts from RCTs12,13 and 17 cohorts from OS,4,23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38 with a total of 28,754 CTO PCI cases, 10,386 with TRA (36.12%), and 18,368 with TFA (63.88%). Most studies were performed in Europe and North America, of which 4 were multicenter registries.4,31,37,38 The number of cases
Discussion
To our knowledge, this is the largest systematic review and meta-analysis to date, reporting on studies comparing the transradial with the transfemoral approach for treating CTO by PCI. The salient findings of our synthesis of 19 studies, including 28,754 cases, are 1) the procedural success rate of CTO cases that underwent PCI was comparable between TRA and TFA; (2) TRA in CTO PCI resulted in a significantly lower incidence of access-site complications and major bleeding than did TFA; 3) a
Disclosures
The authors have no conflicts of interest to declare.
Declaration of Interests
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:
References (47)
- et al.
Femoral versus radial artery access for CTO PCIs: is this the final round?
JACC Cardiovasc Interv
(2022) - et al.
Vascular access site and outcomes among 26,807 chronic total coronary occlusion angioplasty cases from the British cardiovascular interventions society national database
JACC Cardiovasc Interv
(2017) - et al.
Procedural outcomes of percutaneous coronary interventions for chronic total occlusions via the radial approach: insights from an international chronic total occlusion registry
JACC Cardiovasc Interv
(2019) - et al.
Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial
Lancet
(2011) - et al.
Meta-analysis comparing transradial with transfemoral access in the treatment of coronary chronic total occlusion
Am J Cardiol
(2022) - et al.
Randomized comparison between radial and femoral large-bore access for complex percutaneous coronary intervention
JACC Cardiovasc Interv
(2021) - et al.
Femoral or radial approach in treatment of coronary chronic total occlusion: a randomized clinical trial
JACC Cardiovasc Interv
(2022) - et al.
Comparison of clinical outcomes of transradial versus transfemoral percutaneous coronary intervention for chronic total occlusion
Am J Cardiol
(2011) - et al.
TCT-456 Radial approach to cto re-canalisation is as successful and safer than femoral: single centre observational study
J Am Coll Cardiol
(2012) - et al.
Radial versus femoral access for percutaneous coronary interventions in patients with chronic total occlusion
J Am Coll Cardiol
(2012)
Transradial coronary interventions for complex chronic total occlusions
JACC Cardiovasc Interv
Comparison between radial versus femoral percutaneous coronary intervention access in Indonesian hospitals, 2017-2018: a prospective observational study of a national registry
Int J Cardiol Heart Vasc
Radial versus femoral randomized investigation in ST-segment elevation acute coronary syndrome: the RIFLE-STEACS (radial versus femoral randomized investigation in ST-elevation acute coronary syndrome) study
J Am Coll Cardiol
ST-segment elevation myocardial infarction treated by radial or femoral approach in a multicenter randomized clinical trial: the STEMI-RADIAL trial
J Am Coll Cardiol
Transradial approach for chronic total occlusion percutaneous coronary intervention
Interv Cardiol Clin
Access selection for chronic total occlusion percutaneous coronary intervention and complication management
Interv Cardiol Clin
Radial or femoral approach for chronic total occlusion revascularization?: The answer is both
JACC Cardiovasc Interv
Dual lumen microcatheters for complex percutaneous coronary interventions
Cardiovasc Revasc Med
Guide catheter extension systems: hype or a need?
Indian Heart J
The role of multimodality imaging for percutaneous coronary intervention in patients with chronic total occlusions
Front Cardiovasc Med
Treatment of coronary chronic total occlusion by transradial approach: current trends and expert recommendations
Cardiol J
Radial versus femoral access in chronic total occlusion percutaneous coronary intervention
Circ Cardiovasc Interv
Cited by (1)
The Evolving Role of Transradial Access in Chronic Total Occlusion Percutaneous Coronary Intervention
2023, American Journal of Cardiology