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Conventional vascular access site approach versus fully trans-wrist approach for chronic total occlusion percutaneous coronary intervention: a multicenter registry.
- Source :
-
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions [Catheter Cardiovasc Interv] 2020 Jul; Vol. 96 (1), pp. E45-E52. Date of Electronic Publication: 2019 Oct 09. - Publication Year :
- 2020
-
Abstract
- Objectives: To evaluate the incidence of vascular complication and major bleeding in patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI) with a fully trans-wrist access (TWA) approach versus a conventional approach based on trans-femoral access (TFA).<br />Background: TFA is the preferred vascular access in CTO PCI, but it has been associated with a non-negligible risk of complications.<br />Methods: This retrospective registry included all patients undergoing CTO PCI at five institutions between July 2011 and October 2018. Patients were divided into two groups: Conventional (patients treated with at least one TFA) and Fully TWA (subjects exclusively treated with one or two TWA). The primary safety endpoint was a composite of vascular complications and major bleeding. The primary efficacy endpoint was procedural success.<br />Results: We included 1,900 patients (Conventional n = 1,496 and Fully TWA n = 404). Conventional patients showed higher occlusion complexity (J-CTO score 2.1 ± 1.2 vs. 1.5 ± 1.1, p < .001). Procedural success showed no significant difference between both groups (85.7 vs. 83.0%, p = .17). The primary safety endpoint occurred more frequently in the Conventional group (10.3 vs. 4.5%, p < .001), driven by vascular complications (9.4 vs. 3.7%, p < .001). On multivariate analysis, not using a Fully TWA approach was an independent predictor of the study endpoint, after adjusting for age, sex, diabetes, body mass index, chronic kidney disease, prior coronary artery bypass graft, and J-CTO score.<br />Conclusions: Embracing a Fully TWA approach for CTO PCI might be associated with lower incidence of a composite endpoint of vascular complications and major bleeding, compared with a Conventional approach.<br /> (© 2019 Wiley Periodicals, Inc.)
- Subjects :
- Aged
Chronic Disease
Coronary Occlusion diagnostic imaging
Europe
Female
Hemorrhage etiology
Humans
Male
Middle Aged
Punctures
Registries
Retrospective Studies
Stents
Treatment Outcome
Vascular Diseases etiology
Catheterization, Peripheral adverse effects
Coronary Occlusion therapy
Femoral Artery
Percutaneous Coronary Intervention adverse effects
Percutaneous Coronary Intervention instrumentation
Wrist blood supply
Subjects
Details
- Language :
- English
- ISSN :
- 1522-726X
- Volume :
- 96
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
- Publication Type :
- Academic Journal
- Accession number :
- 31596537
- Full Text :
- https://doi.org/10.1002/ccd.28513