Simsek, Bahadir, Gorgulu, Sevket, Kostantinis, Spyridon, Karacsonyi, Judit, Alaswad, Khaldoon, Reddy, Niranjan, Jaffer, Farouc A, Doshi, Darshan, Khatri, Jaikirshan, Young, Laura, Poommipanit, Paul, GOKTEKIN, OMER, Krestyaninov, Oleg, Davies, Rhian, El Guindy, Ahmed, Kerrigan, Jimmy, PATEL, MITUL P, Elbarouni, Basem, Rinfret, Stephane, Jaber, Wissam, Nicholson, William, Dattilo, Philip, Abi Rafeh, Nidal, FACC, Rangan, Bavana V, Mastrodemos, Olga, Allana, Salman S, Burke, M Nicholas, KUTUZIS, MICHAEL, and Brilakis, Emmanouil S
Introduction:Use of radial access for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has been increasing.Methods:We examined the clinical characteristics and procedural outcomes of patients who underwent CTO PCI with radial versus femoral access in the Prospective Global Registry for the Study of CTO Intervention (PROGRESS-CTO, NCT02061436).Results:Of 10,954 patients who underwent CTO PCI at 55 centers in 7 countries between 2012 and 2022, 2,578 (24%) had a radial-only approach. Patients who underwent radial-only access were younger (63 ± 10 vs. 65 ± 10, years, p<0.001), more likely to be men (84% vs. 81%, p=0.001), and had a significantly lower prevalence of comorbidities compared with the femoral group, including diabetes mellitus (39% vs. 45%, p<0.001) and coronary artery bypass graft surgery (57% vs. 64%, p<0.001). In addition, radial-only cases had lower angiographic complexity with lower J-CTO (2.0 ± 1.3 vs. 2.5 ± 1.2, p<0.001) and PROGRESS-CTO (1.2 ± 1.0 vs. 1.3 ± 1.0, p<0.001) scores. After adjusting for potential confounders, radial-only access was associated with a lower risk of access site complications (odds ratio [OR]: 0.45, 95% confidence interval [CI], 0.22-0.91), similar technical success (OR: 0.87, 95% CI, 0.74-1.04) and major adverse cardiovascular events (MACE) (OR: 0.65, 95% CI, 0.40-1.07), compared with the femoral access group (Figure 1).Conclusions:Radial-only access was used in 24% of CTO PCIs and was associated with lower access site complications, and similar technical success and MACE compared with the femoral access group.