Vol 24, No 6 (2017)
Review articles — Interventional cardiology
Published online: 2017-06-12

open access

Page views 1797
Article views/downloads 1625
Get Citation

Connect on Social Media

Connect on Social Media

Treatment of coronary chronic total occlusion by transradial approach: Current trends and expert recommendations

Leszek Bryniarski, Michał Zabojszcz, Krzysztof L. Bryniarski
Pubmed: 28612905
Cardiol J 2017;24(6):695-699.


The aim of this review is to highlight the technical details and the scientific data on percutaneous coronary interventions (PCIs) in chronic total occlusion (CTO) performed by transradial approach (TRA). Transfemoral approach (TFA) is commonly regarded as the standard for CTO PCI, but there is a growing number of CTO recanalization procedures performed by TRA. We discuss the relevant technical details to approach a CTO by transradial access, especially the compatibility of various CTO recanalization techniques with specific guiding catheter sizes. Randomized prospective trials in this field are lacking and only data from observational studies are available. We can conclude that transradial access for CTO PCI is feasible and could be very useful in selected patients. In our opinion, transradial access in CTO PCIs should be limited to operators and centers highly experienced in CTO recanaliza¬tion and in TRA.

Article available in PDF format

View PDF Download PDF file


  1. Jolly S, Yusuf S, Cairns J, et al. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. The Lancet. 2011; 377(9775): 1409–1420.
  2. Roffi M, Patrono C, Collet JP, et al. Authors, Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016; 37(3): 267–315.
  3. Burzotta F, De Vita M, Lefevre T, et al. Radial approach for percutaneous coronary interventions on chronic total occlusions: technical issues and data review. Catheter Cardiovasc Interv. 2014; 83(1): 47–57.
  4. Wu CJ, Fang HY, Cheng CI, et al. The safety and feasibility of bilateral radial approach in chronic total occlusion percutaneous coronary intervention. Int Heart J. 2011; 52(3): 131–138.
  5. Jaguszewski M, Ciecwierz D, Gilis-Malinowska N, et al. Successful versus unsuccessful antegrade recanalization of single chronic coronary occlusion: eight-year experience and outcomes by a propensity score ascertainment. Catheter Cardiovasc Interv. 2015; 86(2): E49–E57.
  6. Bryniarski L, Surowiec S, Klima Ł, et al. Recanalisation of coronary chronic total occlusion by retrograde approach: the first experience in Poland. Kardiol Pol. 2015; 73(3): 167–176.
  7. Sianos G, Werner GS, Galassi AR, et al. EuroCTO Club. Recanalisation of chronic total coronary occlusions: 2012 consensus document from the EuroCTO club. EuroIntervention. 2012; 8(1): 139–145.
  8. Galassi AR, Tomasello SD, Reifart N, et al. In-hospital outcomes of percutaneous coronary intervention in patients with chronic total occlusion: insights from the ERCTO (European Registry of Chronic Total Occlusion) registry. EuroIntervention. 2011; 7(4): 472–479.
  9. Di Mario C, Werner GS, Sianos G, et al. European perspective in the recanalisation of Chronic Total Occlusions (CTO): consensus document from the EuroCTO Club. EuroIntervention. 2007; 3(1): 30–43.
  10. Ghione M, Agudo P, Kilickesmez K, et al. Tools and techniques - clinical: catheter compatibility in CTO recanalisation. EuroIntervention. 2013; 9(2): 290–291.
  11. Nakashima M, Ikari Y, Aoki J, et al. Intravascular ultrasound-guided chronic total occlusion wiring technique using 6 Fr catheters via bilateral transradial approach. Cardiovasc Interv Ther. 2015; 30(1): 68–71.
  12. Wu CJ. Feasibility of bilateral radial access antegrade and retrograde approach for CTO lesions: Single center experience. Personal communication TCT 2008. www.tctmd.com.
  13. Ferrante G, Louvard Y, Hayashida K, et al. TCT-445 Radial Versus Femoral Access for Percutaneous Coronary Interventions in Patients With Chronic Total Occlusion. Journal of the American College of Cardiology. 2012; 60(17): B128.
  14. Yang CH, Guo GBF, Chen SM, et al. Feasibility and safety of a transradial approach in intervention for chronic total occlusion of coronary arteries: a single-center experience. Chang Gung Med J. 2010; 33(6): 639–645.
  15. Burzotta F, Trani C, Tommasino A, et al. Impact of operator experience and wiring technique on procedural efficacy of trans-radial percutaneous chronic total occlusion recanalization performed by dedicated radialists. Cardiol J. 2013; 20(5): 560–567.
  16. Liu W, Wagatsuma K, Toda M, et al. Short- and long-term follow-up of percutaneous coronary intervention for chronic total occlusion through transradial approach: tips for successful procedure from a single-center experience. J Interv Cardiol. 2011; 24(2): 137–143.
  17. Rinfret S, Joyal D, Nguyen CM, et al. Retrograde recanalization of chronic total occlusions from the transradial approach; early Canadian experience. Catheter Cardiovasc Interv. 2011; 78(3): 366–374.
  18. Alaswad K, Menon RV, Christopoulos G, et al. Transradial approach for coronary chronic total occlusion interventions: Insights from a contemporary multicenter registry. Catheter Cardiovasc Interv. 2015; 85(7): 1123–1129.
  19. Loh YJ, Nakao M, Tan WD, et al. Factors influencing radial artery size. Asian Cardiovasc Thorac Ann. 2007; 15(4): 324–326.
  20. Caputo RP, Tremmel JA, Rao S, et al. Transradial arterial access for coronary and peripheral procedures: executive summary by the Transradial Committee of the SCAI. Catheter Cardiovasc Interv. 2011; 78(6): 823–839.
  21. Bryniarski KL, Zabojszcz M, Dębski G, et al. Knowledge of chronic total occlusion among Polish interventional cardiologists. Advances in Interventional Cardiology. 2015; 2: 89–94.