Feasibility of slender CTO PCI by trans-radial approach along with limited use of hardware in a diabetic population
Presenter
F. Aaysha Cader, M.D., FSCAI, Kettering General Hospital NHS Foundation Trust, KETTERING, Dhaka, United Kingdom
F. Aaysha Cader, M.D., FSCAI, Kettering General Hospital NHS Foundation Trust, KETTERING, Dhaka, United Kingdom and Saidur Rahman Khan, MD, PhD, Ibrahim Cardiac Hospital and Research Institute, Dhaka, Bangladesh, Dhaka, Bangladesh
Keywords: Chronic Total Occlusion (CTO), Complex and High-risk Coronary Intervention (CHIP) and Coronary
Background
Percutaneous revascularization of chronic total occlusions (CTO) is challenging, particularly by transradial approach in case of narrow radial arteries. We aimed to investigate if a slender technique by transradial approach using 5 French guide and smaller profile balloon is a feasible option for successful crossing of CTO in diabetic patients with narrower radial arteries.
Methods
This was a retrospective observational study conducted over a 2-year period. Demographic and procedural data were derived from hospital records and catheterization laboratory data base. Statistical analysis was done by SPSS Version 24.0.
Results
249 CTO PCI were attempted by transradial access. The majority of cases were J-CTO score ≥1, equally distributed between 5 French (F) vs 6 French groups. 166 (67.2%) were done using 5 F guide and 81 (33.8%) with 6 F guide. All procedures were performed by antegrade wire escalation. Success rates in both groups were 72.7% vs 74.1 % for 5F vs 6F respectively (p=0.82). Crossover to larger guide was 3.2% vs 2.9% for 5F vs 6F respectively (p=0.62). A single 6F case was switched over to femoral. Either small profile balloon support (usually 1.25x5 mm semi-compliant balloon) or microcatheter was used, with comparable success rates in both groups. Active support was achieved by deep intubation of guide with alpha, gamma and epsilon loops in 5 F group. Initial workhorse CTO guidewires used were Gaia First (68.6%), Gaia Second (12.3%), thin hydrophilic PT2 (Boston Scientific) wire (19.1%). One coronary perforation was noted in the 6 F group. Contrast volume was lower in 5 F group, although not statistically significant (152 vs 165 ml, p=0.26). Fluoroscopy time and procedural times were comparable between both groups.
Conclusions
5 F guide is a feasible approach for CTO PCI with equal success rates, allowing more active support by transradial route, complemented by use of low-profile balloon, offering a feasible approach to slender CTO PCI, with limited hardware, reduced fluoroscopy and procedural time, and diminished radial spasm.