Transradial Versus Transfemoral Method of Percutaneous Coronary Revascularization for Unprotected Left Main Coronary Artery Disease: Comparison of Procedural and Late-Term Outcomes

OBJECTIVES: This study intended to compare outcomes between transradial (TR) and transfemoral (TF) percutaneous revascularization in high-risk coronary anatomy. The feasibility, efficacy and safety between TR and TF methods of percutaneous coronary revascularization for unprotected left main coronary artery (UPLM]) disease have not been compared.

METHODS: Among 821 consecutive patients with UPLM disease treated with percutaneous revascularization by either TR (n = 353) or TF (n = 468) vascular access, procedural outcomes, resource use, in-hospital bleeding, and late clinical events were compared according to vascular access method.

RESULTS: Clinical and angiographic characteristics were similar between groups, except that TR patients less commonly presented with unstable angina and had less UPLM bifurcation disease requiring treatment with 2 stents. No significant differences were observed between TR and TF methods for procedural success (97% TF vs. 96% TR, p = 0.57) or total procedural time. However, duration of hospital stay and in-hospital occurrence of Thrombosis In Myocardial Infarction (TIMI) major or minor bleeding (0.6% vs. 2.8%, p = 0.02) were significantly lower with TR access. Using propensity score modeling (254 matched pairs), over a mean follow-up period of 17 months, rates of cardiovascular death (1.2% vs. 2.0%, p = 0.48), nonfatal myocardial infarction (4.7% vs. 2.4%, p = 0.16), stent thrombosis (0.8% vs. 2.8%, p = 0.10) and any target vessel revascularization (6.0% vs. 6.7%, p = 0.72) did not statistically differ among TR and TF groups, respectively.

CONCLUSIONS: In contrast to TF vascular access, TR percutaneous coronary revascularization for UPLM disease is feasible and associated with similar procedural success, abbreviated hospitalization, reduced bleeding, and comparable late-term clinical safety and efficacy. 

PMID:

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2 Comments

  1. See also:

    Transradial Approach for Coronary Angiography and Interventions: Results of the First International Transradial Practice Survey.
    Olivier F. Bertrand, Sunil V. Rao, Samir Pancholy, Sanjit S. Jolly, Josep Rodés-Cabau, Éric Larose, Olivier Costerousse, Martial Hamon, and Tift Mann
    J Am Coll Cardiol Intv 2010;3 1022-1031.

    And post from October 9th:

    Ultrasound-Guided Catheterization of the Radial Artery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
    Shiloh AL, Savel RH, Paulin LM, Eisen LA
    Chest. 2010; 138(4):767-775.
    PMID:

  2. Interesting data! It is clear that trans radial intervention reduces bleeding risk.
    Newer equipment including 7 or 8 Fr sheath less guiding catheters and other dedicated right radial catheters may increase the use of a trans radial approach including in complex PCI cases such as unprotected left main interventions.
    The RIVAL study (from the OASIS group) is currently enrolling patients comparing TF vs TR PCI in ACS patients undergoing early PCI.

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