6-Month Outcomes of the CARPOOL Study: Radial-to-Peripheral Versus Femoral Access in Lower Extremity PAD Revascularization
Presenter
Sameh Sayfo, MD, MBA, FSCAI, Baylor Scott & White The Heart Hospital - Plano, Plano, TX
Sameh Sayfo, MD, MBA, FSCAI1, Minseob Jeong, M.D.2, Anand Gupta, MBBS, MPH2, Sarah Weideman, BS2, Sagar Mukhida, MPH, BDS2, Kennedy S Adelman, BBA2, Madhura Shah, BS, MPH3, Parker Wilson, M.D.4, Ghadi Moubarak, M.D.5, Chadi Dib, M.D., FSCAI1, David fernandez-Vazquez, M.D.2, Tony Das, M.D., FSCAI6, Zach Rosol, MD, FSCAI7, John Eidt, MD8, Srinivasa Potluri, MD1 and Subhash Banerjee, M.D., FSCAI8, (1)Baylor Scott & White The Heart Hospital - Plano, Plano, TX, (2)Baylor Scott & White Research Institute, Dallas, TX, (3)Baylor Scott & White Research Institute, Plano, TX, (4)Baylor University Medical Center, Dallas, TX, (5)Baylor Scott and White The Heart Hospital research institute, Plano, TX, (6)Baylor Scott & White The Heart Hospital - Plano, Dallas, TX, (7)Baylor Scott & White - The Heart Hospital, Dallas, TX, (8)Baylor Scott & White Heart and Vascular Hospital - Dallas, Dallas, TX
Keywords: Complications, Peripheral Artery Disease (PAD) and Vascular Access, Management, and Closure
Background
Radial-to-peripheral (R2P) access for peripheral artery interventions is gaining traction, although comparative data with traditional common femoral artery (CFA) access remain limited.
Methods
Consecutive R2P procedures were propensity-matched 1:1 to CFA cases from the multicenter, core laboratory-adjudicated XLPAD registry (2003–2024, NCT01904851), adjusting for demographic, cardiovascular risk and clinical presentation. The primary endpoint was 6-month major adverse limb events (MALE), a composite of all-cause mortality, target vessel revascularization (TVR), and major amputation, analyzed by multivariable Cox proportional hazards model.
Results
Among a total of 546 patients (mean age 71±9 years; 32% women; 78% claudicants) nearly 50% of lesions were chronic total occlusions. Mean lesion lengths were longer in the CFA group (129 ± 92 mm vs 98 ± 92 mm; p<0.01). Stent (56%) and drug-coated balloon (29%) use were similar between groups. Technical success favored CFA (95% vs 87%) but remained clinically non-inferior (p=0.001; prespecified margin 15%). At 6 months, the R2P group had higher MALE (15.8% vs 8.1%; HR 1.99, 95% CI 1.19-3.35; p=0.006; Figure 1), mainly driven by TVR (11.7% vs 5.1%; p=0.006), with similar rates of death (3.3%) and major amputation (1.1%).
Conclusions
In this largest real-world comparison to date, R2P achieved non-inferior technical success and comparable periprocedural outcomes to CFA. However, higher 6-month MALE was associated with R2P, predominantly driven by TVR. 