The Suitability of Percutaneous Transradial Coronary Intervention for Chronic Total Occlusion (CTO) - An Experience at PIC

Background: Intervention of chronic total coronary artery occlusion is quite challenging. The usual vascular route used in PCI for CTO in most cardiac catheterization laboratories is through femoral artery. In this study we evaluated the feasibility of transradial coronary intervention in CTO. Study Design: Interventional descriptive study. Place and Duration of Study: Department of cardiac catheterization and interventional cardiology of Punjab Institute of Cardiology, Lahore from July 2007 to January 2009. Methods: We examined 170 lesions in patients with positive Allen's test. Patients with negative Allen's test and chronic renal failure patients on dialysis were excluded. Chronic total occlusion (CTO) were divided into early (< 3 months) and late (> 3 months) occlusions. Transradial PCI was performed via right radial artery with 6Fr arterial sheath and 7500 to 10,000 IU of heparin was administered during procedure. Statistical analysis was performed using SPSS 12.0 and different variables were expressed in frequencies or percentages and groups were assessed by student's t-test. p-value of < 0.005 was considered significant. Results: The baseline clinical characteristics of 170 cases in success and failure groups were compared with no significant differences in coronary artery disease risk factors. The clinical diagnosis was unstable angina in 68 (40%), stable angina in 52 (30.6%) and other presentations like heart failure in 50 (29.4%) cases. The site of occlusion was left anterior descending in 89 (52.35%), right coronary artery in 61 (35.88%) and left circumflex in 20 (11.76%) cases. The duration of chronic occlusion was 1.5 +/- 1 month in success group and 3.5 +/- 3 months in failure group, showing significantly longer duration in failure group (p < 0.01). The success rate of transradial PCI was approximately 68.23% (116 of 170 cases). The lesion characteristics that correlated with successful PCI included lack of side branches, bridging collaterals, tapered occlusion and occlusion of less than 15mm. The main cause of failure was failure to pass guide wire in 44 (81.48%). In 10 cases, PCI was crossed over to femoral artery due to poor guiding catheter support, subclavian / radial artery tortuousity. Procedure related complications occurred in 6 cases with coronary artery dissection in 4 cases and perforation in 2 cases. Conclusion: The transradial approach is suitable vascular route in coronary interventions for CTO with the use of newer PCI equipments.