The following is a summary of “Alternative (Transulnar or Distal Radial) Arterial Access for Chronic Total Occlusion Percutaneous Coronary Intervention (Subanalysis from the Minimalistic Hybrid Approach Algorithm Registry),” published in the August 2023 issue of the Cardiovascular Disease by Poletti et al.

The trans-radial approach (TRA) has emerged as the predominant selection for percutaneous coronary intervention (PCI); moreover, its applicability may be improved by clinical and technical complexities. Alternative forearm accesses, such as the translunar approach (TUA) and distal radial approach (dTRA), may enable the preservation of a wrist approach for the medical procedure, thereby avoiding the use of the femoral artery. This matter is especially pertinent in patients undergoing multiple revascularization procedures, such as those with chronic total occlusion (CTO) lesions. This study sought to assess the comparability of TUA and dTRA with TRA in chronic total occlusion percutaneous coronary intervention (CTO PCI) using a minimalistic hybrid approach algorithm, which aims to reduce the occurrence of vascular access complications by limiting the number of accesses utilized. 

Patients with chronic total occlusion percutaneous coronary intervention (CTO PCI) managed exclusively using an entirely alternative approach (translunar artery or distal radial artery) were compared to those contained exclusively using a standard trans-radial artery approach (TRA). The primary measure of effectiveness was procedural success, while the primary safety measure was the combination of major adverse cardiac and cerebral events and vascular complications. Of 201 cases of chronic total occlusion percutaneous coronary interventions (CTO PCIs), 154 procedures were deemed suitable for analysis. 

Among these, 104 procedures followed the standard approach, while 50 followed an alternative path. Both alternative and traditional groups exhibited similar rates of procedural success (92% vs. 94.2%, P = 0.70) and primary safety endpoint (4.8% vs 6.0%, P = 0.70). It is noteworthy that in the alternative group, there was a higher utilization rate of 7 French guiding catheters (44% vs 26%, P = 0.028). In conclusion, performing CTO PCI using alternative forearm vascular accesses (dTRA or TUA) through a minimalistic hybrid approach is feasible and safe compared to CTO PCI using the standard TRA method.

Source: sciencedirect.com/science/article/abs/pii/S0002914923002874