Trans-Radial versus Trans-Femoral Intervention for the Treatment of Coronary Bifurcations: Results from Coronary Bifurcation Stenting Registry

Abstract

Trans-radial (TR) approach is increasingly recognized as an alternative to the routine use of trans-femoral (TF) approach. However, there are limited data comparing the outcomes of these two approaches for the treatment of coronary bifurcation lesions. We evaluated outcomes of TR and TF percutaneous coronary interventions (PCI) in this complex lesion. Procedural outcomes and clinical events were compared in 1,668 patients who underwent PCI for non-left main bifurcation lesions, according to the vascular approach, either TR (n = 503) or TF (n = 1,165). The primary outcome was major adverse cardiac events (MACE), including cardiac death, myocardial infarction (MI), and target lesion revascularization (TLR) in all patients and in 424 propensity-score matched pairs of patients. There were no significant differences between TR and TF approaches for procedural success in the main vessel (99.6% vs 98.6%, P = 0.08) and side branches (62.6% vs 66.7%, P = 0.11). Over a mean follow-up of 22 months, cardiac death or MI (1.8% vs 2.2%, P = 0.45), TLR (4.0% vs 5.2%, P = 0.22), and MACE (5.2% vs 7.0%, P = 0.11) did not significantly differ between TR and TF groups, respectively. These results were consistent after propensity score-matched analysis. In conclusion, TR PCI is a feasible alternative approach to conventional TF approaches for bifurcation PCI (clinicaltrials.gov number: NCT00851526).

Left main percutaneous coronary intervention—Radial versus femoral access: A systematic analysis

“…Major bleeding occurred in 76 patients (0.92%) among the 8,240 eligible patients in four studies . The odds of major bleeding were significantly lower in TRA compared to TFA (OR = 0.44; 95% CI = 0.27–0.69, I 2 = 0%, p = .0005; Figure a).…”

“…The initial search identified 6,066 publications that were screened at the abstract level, of which 337 reports were eligible for full‐text review after exclusion of duplicate and irrelevant studies. After full‐text review, 12 studies were included in the final analysis . Out of those 12 studies, four studies were propensity‐matched and one of the studies had subgroup analysis from the EXCEL trial .…”

“…After full‐text review, 12 studies were included in the final analysis . Out of those 12 studies, four studies were propensity‐matched and one of the studies had subgroup analysis from the EXCEL trial . Together, these studies included 17,258 patients, with 7,971 patients in TRA group and 9,287 patients in TFA group.…”

“…Salient features of individual studies are shown in Table . Six of twelve studies were multicenter studies and the other six were single‐center studies . Overall, patients in the two arms were well matched for baseline characteristics.…”

Transradial versus transfemoral percutaneous coronary intervention of left main disease: A systematic review and meta‐analysis of observational studies

“…Prior studies reported the advantages of the Glidesheath Slender (7 French) or 7.5-Fr sheathless guide catheter in complex PCI including the LM with high procedural success and low vascular complication rate, therefore, potentially could mitigate the disadvantages of sheath size that may come up with TR-PCI. 32 Gili et al 5 De Maria et al 16 Chung et al 17 Study design De Maria et al 16 Chung et al 17 Key inclusion/exclusion criteria • Previous coronary intervention to LM was excluded.…”