Fully Transradial Versus Transfemoral Approach for Percutaneous Intervention of Coronary Chronic Total Occlusions Applying the Hybrid Algorithm: Insights From RECHARGE Registry

Erik Jan Bakker; Joren Maeremans; Carlo Zivelonghi; Benjamin Faurie; Alexandre Avran; Simon Walsh; James C. Spratt; Paul Knaapen; Colm G. Hanratty; Erwan Bressollette; Peter Kayaert; Alan J. Bagnall; Mohaned Egred; David Smith; Margaret B. McEntegart; William H. T. Smith; Paul Kelly; John Irving; Elliot J. Smith; Julian W. Strange; Joseph Dens; Pierfrancesco Agostoni

doi:10.1161/CIRCINTERVENTIONS.117.005255

Fully Transradial Versus Transfemoral Approach for Percutaneous Intervention of Coronary Chronic Total Occlusions Applying the Hybrid Algorithm: Insights From RECHARGE Registry

Erik Jan Bakker, Joren Maeremans, Carlo Zivelonghi, Benjamin Faurie, Alexandre Avran, Simon Walsh, James C. Spratt, Paul Knaapen, Colm G. Hanratty, Erwan Bressollette, Peter Kayaert, Alan J. Bagnall, Mohaned Egred, David Smith, Margaret B. McEntegart, William H. T. Smith, Paul Kelly, John Irving, Elliot J. Smith, Julian W. StrangeJoseph Dens, Pierfrancesco Agostoni (Lead / Corresponding author)

Research output: Contribution to journal › Article › peer-review

38 Citations (Scopus)

Abstract

Background: Small observational studies demonstrate the feasibility of transradial approach for chronic total occlusion (CTO) percutaneous coronary intervention. The aim of the current study is to assess technical success, complication rates, and procedural efficiency in fully transradial approach (fTRA) and transfemoral approach (TFA) in a large prospective European registry adopting the hybrid algorithm for CTO percutaneous coronary intervention (Registry of CrossBoss and Hybrid Procedures in France, the Netherlands, Belgium and United Kingdom, RECHARGE registry).

Methods and Results: We analyzed 1253 CTO percutaneous coronary intervention procedures performed according to the hybrid protocol in 17 European centers, comparing fTRA (single or biradial access) and TFA (single or bifemoral or combined radial and femoral access). fTRA was applied in 306 (24%) and TFA in 947 (76%) cases. The average Japanese CTO score was 2.1±1.2 in fTRA and 2.3±1.1 in TFA (P=0.06). Technical success was achieved in 85% in fTRA and 86% in TFA (P=0.51). Technical success was comparable for fTRA and TFA in different Japanese CTO score subgroups after multivariable analysis and after propensity adjustment. In-hospital major adverse cardiac and cerebral events occurred in 2.0% in fTRA and 2.9% in TFA (P=0.40). Major access site bleeding occurred in 0.3% in fTRA and 0.5% in TFA (P=0.66). fTRA compared with TFA had similar procedural duration (80 minutes [54-120 minutes] versus 90 minutes [60-121 minutes]; P=0.07), similar radiation dose (dose area product 89 Gray×cm(2) [52-163 Gray×cm(2)] versus 101 Gray×cm(2) [59-171 Gray×cm(2)]; P=0.06), and lower contrast agent use (200 mL [150-310 mL] versus 250 mL [200-350 mL]; P<0.01).

Conclusions: fTRA CTO percutaneous coronary intervention is a valid alternative to TFA with a high rate of success, low complication rates, and no decrease in procedural efficiency.

Original language	English
Article number	e005255
Journal	Circulation: Cardiovascular Interventions
Volume	10
Issue number	9
Early online date	29 Aug 2017
DOIs	https://doi.org/10.1161/CIRCINTERVENTIONS.117.005255
Publication status	Published - Sept 2017

Keywords

Coronary occlusion
Percutaneous coronary intervention
Prospective studies
Radial artery
Registries

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10.1161/CIRCINTERVENTIONS.117.005255

Cite this

Bakker, E. J., Maeremans, J., Zivelonghi, C., Faurie, B., Avran, A., Walsh, S., Spratt, J. C., Knaapen, P., Hanratty, C. G., Bressollette, E., Kayaert, P., Bagnall, A. J., Egred, M., Smith, D., McEntegart, M. B., Smith, W. H. T., Kelly, P., Irving, J., Smith, E. J., ... Agostoni, P. (2017). Fully Transradial Versus Transfemoral Approach for Percutaneous Intervention of Coronary Chronic Total Occlusions Applying the Hybrid Algorithm: Insights From RECHARGE Registry. Circulation: Cardiovascular Interventions, 10(9), Article e005255 . https://doi.org/10.1161/CIRCINTERVENTIONS.117.005255

@article{cd8dc22e46dd4bad92cc1f6281ea0597,

title = "Fully Transradial Versus Transfemoral Approach for Percutaneous Intervention of Coronary Chronic Total Occlusions Applying the Hybrid Algorithm: Insights From RECHARGE Registry",

abstract = "Background: Small observational studies demonstrate the feasibility of transradial approach for chronic total occlusion (CTO) percutaneous coronary intervention. The aim of the current study is to assess technical success, complication rates, and procedural efficiency in fully transradial approach (fTRA) and transfemoral approach (TFA) in a large prospective European registry adopting the hybrid algorithm for CTO percutaneous coronary intervention (Registry of CrossBoss and Hybrid Procedures in France, the Netherlands, Belgium and United Kingdom, RECHARGE registry).Methods and Results: We analyzed 1253 CTO percutaneous coronary intervention procedures performed according to the hybrid protocol in 17 European centers, comparing fTRA (single or biradial access) and TFA (single or bifemoral or combined radial and femoral access). fTRA was applied in 306 (24%) and TFA in 947 (76%) cases. The average Japanese CTO score was 2.1±1.2 in fTRA and 2.3±1.1 in TFA (P=0.06). Technical success was achieved in 85% in fTRA and 86% in TFA (P=0.51). Technical success was comparable for fTRA and TFA in different Japanese CTO score subgroups after multivariable analysis and after propensity adjustment. In-hospital major adverse cardiac and cerebral events occurred in 2.0% in fTRA and 2.9% in TFA (P=0.40). Major access site bleeding occurred in 0.3% in fTRA and 0.5% in TFA (P=0.66). fTRA compared with TFA had similar procedural duration (80 minutes [54-120 minutes] versus 90 minutes [60-121 minutes]; P=0.07), similar radiation dose (dose area product 89 Gray×cm(2) [52-163 Gray×cm(2)] versus 101 Gray×cm(2) [59-171 Gray×cm(2)]; P=0.06), and lower contrast agent use (200 mL [150-310 mL] versus 250 mL [200-350 mL]; P<0.01).Conclusions: fTRA CTO percutaneous coronary intervention is a valid alternative to TFA with a high rate of success, low complication rates, and no decrease in procedural efficiency.",

keywords = "Coronary occlusion, Percutaneous coronary intervention, Prospective studies, Radial artery, Registries",

author = "Bakker, {Erik Jan} and Joren Maeremans and Carlo Zivelonghi and Benjamin Faurie and Alexandre Avran and Simon Walsh and Spratt, {James C.} and Paul Knaapen and Hanratty, {Colm G.} and Erwan Bressollette and Peter Kayaert and Bagnall, {Alan J.} and Mohaned Egred and David Smith and McEntegart, {Margaret B.} and Smith, {William H. T.} and Paul Kelly and John Irving and Smith, {Elliot J.} and Strange, {Julian W.} and Joseph Dens and Pierfrancesco Agostoni",

note = "No funding info",

year = "2017",

month = sep,

doi = "10.1161/CIRCINTERVENTIONS.117.005255",

language = "English",

volume = "10",

journal = "Circulation: Cardiovascular Interventions",

issn = "1941-7640",

publisher = "Lippincott Williams and Wilkins Ltd.",

number = "9",

}

Bakker, EJ, Maeremans, J, Zivelonghi, C, Faurie, B, Avran, A, Walsh, S, Spratt, JC, Knaapen, P, Hanratty, CG, Bressollette, E, Kayaert, P, Bagnall, AJ, Egred, M, Smith, D, McEntegart, MB, Smith, WHT, Kelly, P, Irving, J, Smith, EJ, Strange, JW, Dens, J & Agostoni, P 2017, 'Fully Transradial Versus Transfemoral Approach for Percutaneous Intervention of Coronary Chronic Total Occlusions Applying the Hybrid Algorithm: Insights From RECHARGE Registry', Circulation: Cardiovascular Interventions, vol. 10, no. 9, e005255 . https://doi.org/10.1161/CIRCINTERVENTIONS.117.005255

Fully Transradial Versus Transfemoral Approach for Percutaneous Intervention of Coronary Chronic Total Occlusions Applying the Hybrid Algorithm: Insights From RECHARGE Registry. / Bakker, Erik Jan; Maeremans, Joren; Zivelonghi, Carlo et al.
In: Circulation: Cardiovascular Interventions, Vol. 10, No. 9, e005255 , 09.2017.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Fully Transradial Versus Transfemoral Approach for Percutaneous Intervention of Coronary Chronic Total Occlusions Applying the Hybrid Algorithm

T2 - Insights From RECHARGE Registry

AU - Bakker, Erik Jan

AU - Maeremans, Joren

AU - Zivelonghi, Carlo

AU - Faurie, Benjamin

AU - Avran, Alexandre

AU - Walsh, Simon

AU - Spratt, James C.

AU - Knaapen, Paul

AU - Hanratty, Colm G.

AU - Bressollette, Erwan

AU - Kayaert, Peter

AU - Bagnall, Alan J.

AU - Egred, Mohaned

AU - Smith, David

AU - McEntegart, Margaret B.

AU - Smith, William H. T.

AU - Kelly, Paul

AU - Irving, John

AU - Smith, Elliot J.

AU - Strange, Julian W.

AU - Dens, Joseph

AU - Agostoni, Pierfrancesco

N1 - No funding info

PY - 2017/9

Y1 - 2017/9

N2 - Background: Small observational studies demonstrate the feasibility of transradial approach for chronic total occlusion (CTO) percutaneous coronary intervention. The aim of the current study is to assess technical success, complication rates, and procedural efficiency in fully transradial approach (fTRA) and transfemoral approach (TFA) in a large prospective European registry adopting the hybrid algorithm for CTO percutaneous coronary intervention (Registry of CrossBoss and Hybrid Procedures in France, the Netherlands, Belgium and United Kingdom, RECHARGE registry).Methods and Results: We analyzed 1253 CTO percutaneous coronary intervention procedures performed according to the hybrid protocol in 17 European centers, comparing fTRA (single or biradial access) and TFA (single or bifemoral or combined radial and femoral access). fTRA was applied in 306 (24%) and TFA in 947 (76%) cases. The average Japanese CTO score was 2.1±1.2 in fTRA and 2.3±1.1 in TFA (P=0.06). Technical success was achieved in 85% in fTRA and 86% in TFA (P=0.51). Technical success was comparable for fTRA and TFA in different Japanese CTO score subgroups after multivariable analysis and after propensity adjustment. In-hospital major adverse cardiac and cerebral events occurred in 2.0% in fTRA and 2.9% in TFA (P=0.40). Major access site bleeding occurred in 0.3% in fTRA and 0.5% in TFA (P=0.66). fTRA compared with TFA had similar procedural duration (80 minutes [54-120 minutes] versus 90 minutes [60-121 minutes]; P=0.07), similar radiation dose (dose area product 89 Gray×cm(2) [52-163 Gray×cm(2)] versus 101 Gray×cm(2) [59-171 Gray×cm(2)]; P=0.06), and lower contrast agent use (200 mL [150-310 mL] versus 250 mL [200-350 mL]; P<0.01).Conclusions: fTRA CTO percutaneous coronary intervention is a valid alternative to TFA with a high rate of success, low complication rates, and no decrease in procedural efficiency.

AB - Background: Small observational studies demonstrate the feasibility of transradial approach for chronic total occlusion (CTO) percutaneous coronary intervention. The aim of the current study is to assess technical success, complication rates, and procedural efficiency in fully transradial approach (fTRA) and transfemoral approach (TFA) in a large prospective European registry adopting the hybrid algorithm for CTO percutaneous coronary intervention (Registry of CrossBoss and Hybrid Procedures in France, the Netherlands, Belgium and United Kingdom, RECHARGE registry).Methods and Results: We analyzed 1253 CTO percutaneous coronary intervention procedures performed according to the hybrid protocol in 17 European centers, comparing fTRA (single or biradial access) and TFA (single or bifemoral or combined radial and femoral access). fTRA was applied in 306 (24%) and TFA in 947 (76%) cases. The average Japanese CTO score was 2.1±1.2 in fTRA and 2.3±1.1 in TFA (P=0.06). Technical success was achieved in 85% in fTRA and 86% in TFA (P=0.51). Technical success was comparable for fTRA and TFA in different Japanese CTO score subgroups after multivariable analysis and after propensity adjustment. In-hospital major adverse cardiac and cerebral events occurred in 2.0% in fTRA and 2.9% in TFA (P=0.40). Major access site bleeding occurred in 0.3% in fTRA and 0.5% in TFA (P=0.66). fTRA compared with TFA had similar procedural duration (80 minutes [54-120 minutes] versus 90 minutes [60-121 minutes]; P=0.07), similar radiation dose (dose area product 89 Gray×cm(2) [52-163 Gray×cm(2)] versus 101 Gray×cm(2) [59-171 Gray×cm(2)]; P=0.06), and lower contrast agent use (200 mL [150-310 mL] versus 250 mL [200-350 mL]; P<0.01).Conclusions: fTRA CTO percutaneous coronary intervention is a valid alternative to TFA with a high rate of success, low complication rates, and no decrease in procedural efficiency.

KW - Coronary occlusion

KW - Percutaneous coronary intervention

KW - Prospective studies

KW - Radial artery

KW - Registries

U2 - 10.1161/CIRCINTERVENTIONS.117.005255

DO - 10.1161/CIRCINTERVENTIONS.117.005255

M3 - Article

C2 - 28851720

SN - 1941-7640

VL - 10

JO - Circulation: Cardiovascular Interventions

JF - Circulation: Cardiovascular Interventions

IS - 9

M1 - e005255

ER -

Bakker EJ, Maeremans J, Zivelonghi C, Faurie B, Avran A, Walsh S et al. Fully Transradial Versus Transfemoral Approach for Percutaneous Intervention of Coronary Chronic Total Occlusions Applying the Hybrid Algorithm: Insights From RECHARGE Registry. Circulation: Cardiovascular Interventions. 2017 Sept;10(9):e005255 . Epub 2017 Aug 29. doi: 10.1161/CIRCINTERVENTIONS.117.005255

Fully Transradial Versus Transfemoral Approach for Percutaneous Intervention of Coronary Chronic Total Occlusions Applying the Hybrid Algorithm: Insights From RECHARGE Registry

Abstract

Keywords

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