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Impact of operator experience and wiring technique on procedural efficacy of trans-radial percutaneous chronic total occlusion recanalization performed by dedicated radialists
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Abstract
Background: The efficacy of trans-radial approach (TRA) in chronic total occlusions (CTO) percutaneous coronary interventions (PCI) is not well established. Thus, we sought to review the feasibility and long-term results of TRA for CTO PCI performed by dedicated TRA operatorsof our center.
Methods: CTO PCI performed by dedicated radialists were considered. Primary end-points were “PCI success” (stent implantation with residual stenosis < 20% and TIMI 3) and “patient success” (PCI success in a first or second attempt). Vascular complications and major adverse cardiac events (MACE) were also assessed. Procedures were divided into: Period 1 — no systematic adoption of TRA nor systematic wire selection, and Period 2 — systematic TRA with stepwise wire selection. The starting guidewire was initially an intermediate wire (Period 2a), and, thereafter, a tapered soft polymeric guidewire (Period 2b).
Results: Two operators performed 167 TRA PCI on CTO in 158 patients. PCI success rate was 74.3% and patient success rate was 78.5%. Drug-eluting stents were implanted in 95.1% of successful procedures. One (0.6%) patient had a (minor) vascular complication. After a mean follow-up of 580 days, 93.7% of patients were free from MACE. PCI success (57.1% in Period 1 vs. 76.5% in Period 2a vs. 80.5% in Period 2b, p = 0.029) and patient success (62.5% in Period 1 vs. 77.8% in Period 2a vs. 86.1% in Period 2b, p = 0.025) significantly improved during the study.
Conclusions: CTO PCI by TRA is safe and feasible. Its efficacy seems to be strongly dependenton operator experience with CTO techniques and may be influenced by the strategy of guidewire selection.
Abstract
Background: The efficacy of trans-radial approach (TRA) in chronic total occlusions (CTO) percutaneous coronary interventions (PCI) is not well established. Thus, we sought to review the feasibility and long-term results of TRA for CTO PCI performed by dedicated TRA operatorsof our center.
Methods: CTO PCI performed by dedicated radialists were considered. Primary end-points were “PCI success” (stent implantation with residual stenosis < 20% and TIMI 3) and “patient success” (PCI success in a first or second attempt). Vascular complications and major adverse cardiac events (MACE) were also assessed. Procedures were divided into: Period 1 — no systematic adoption of TRA nor systematic wire selection, and Period 2 — systematic TRA with stepwise wire selection. The starting guidewire was initially an intermediate wire (Period 2a), and, thereafter, a tapered soft polymeric guidewire (Period 2b).
Results: Two operators performed 167 TRA PCI on CTO in 158 patients. PCI success rate was 74.3% and patient success rate was 78.5%. Drug-eluting stents were implanted in 95.1% of successful procedures. One (0.6%) patient had a (minor) vascular complication. After a mean follow-up of 580 days, 93.7% of patients were free from MACE. PCI success (57.1% in Period 1 vs. 76.5% in Period 2a vs. 80.5% in Period 2b, p = 0.029) and patient success (62.5% in Period 1 vs. 77.8% in Period 2a vs. 86.1% in Period 2b, p = 0.025) significantly improved during the study.
Conclusions: CTO PCI by TRA is safe and feasible. Its efficacy seems to be strongly dependenton operator experience with CTO techniques and may be influenced by the strategy of guidewire selection.
Keywords
radial approach, percutaneous coronary intervention, chronically occluded vessels, procedural efficacy, operator experience, wiring technique
About this articleTitle
Impact of operator experience and wiring technique on procedural efficacy of trans-radial percutaneous chronic total occlusion recanalization performed by dedicated radialists
Journal
Issue
Pages
560-567
Published online
2013-09-23
DOI
10.5603/CJ.a2013.0063
Bibliographic record
Cardiol J 2013;20(5):560-567.
Keywords
radial approach
percutaneous coronary intervention
chronically occluded vessels
procedural efficacy
operator experience
wiring technique
Authors
Francesco Burzotta
Carlo Trani
Antonella Tommasino
Marta Francesca Brancati
Silvia Saffioti
Giancarlo Pirozzolo
Giampaolo Niccoli
Antonio Maria Leone
Giovanni Schiavoni
Filippo Crea