*For medical professionals only
“img class=”responsive ” sizes=”(min-width: 320px) 320px, 100vw” src=”https://mmbiz.qpic.cn/mmbiz_png/x5F5KAyDKw19I4VvcibrfNia7lD1fial5KribXqZxjxMxtoc3ichKKz6ib3w5kJias8QNRBYGn80MM0AxEgOvRLib>p>width=”6400″ >Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has traditionally been performed using transfemoral access (TFA) to allow the use of large catheters and robust device support. Transradial access (TRA) reduces the risk of vascular access complications and has been increasingly used for CTO and complex PCI. A randomized trial comparing TRA and TFA in complex PCI procedures (58% of which were CTO) provided favorable results for TRA, but no dedicated trial of TRA and TFA in CTO PCI has been published.
Recently, JACC: Cardiovascular Interventions published a prospective randomized controlled trial (FORT CTO study) comparing the effects of TRA and TFA on CTO PCI. Check it out.
Methods
The FORT CTO trial was a Prospective, non-inferiority, randomized controlled study to investigate the differences between TRA and TFA approaches for CTO PCI.
The primary endpoint of the study was surgical success, defined as the absence of any major in-hospital adverse cardiovascular events.
The secondary endpoint was the primary approach complication.
Findings
Referrals at 4 centers between 2017 and 2021 Of the 800 CTO PCI patients in the study,
610 were randomly assigned to TRA (n = 305) or TFA (n = 305).
The following metrics were similar between the two groups:
Mean J-CTO (Japanese Multicenter CTO Registry Study) (2.1±0.1 vs 2.2±0.1; P=0.279),
PROGRESS CTO ( Prospective Global Registry of Chronic Total Occlusion Intervention Studies) (1.3±0.9 vs 1.1±1.0; P=0.058),
PROGRESS CTO concurrent Symptom score (2.4±1.8 vs 2.3±1.8; P=0.561),
retrograde (11% vs 14%; P=0.342) .
TRA was not less successful than TFA (84% vs 86%; P = 0.563),
But there were fewer access site complications (2.0% vs 5.6%; P = 0.019).
TFA and TRA did not differ in operative time, contrast dose, or radiation dose.
Fig.1 Main findings of femoral or radial approach in the treatment of coronary CTO< >
Conclusions
In patients with obstructive hypertrophic cardiomyopathy, septal resection is associated with ventricular septal resection
< p>In CTO PCI, TRA is non-inferior to TFA and has fewer access complications.
Source:
Femoral or Radial Approach in Treatment of Coronary Chronic Total Occlusion: A Randomized Clinical Trial. JACC Cardiovasc Interv. 2022;15(8):823-830. doi: 10.1016/j.jcin.2022.02.012
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