Radial access for chronic total occlusion percutaneous coronary intervention: Insights from the PROGRESS-CTO registry

Catheter Cardiovasc Interv. 2022 Nov;100(5):730-736. doi: 10.1002/ccd.30347. Epub 2022 Jul 23.


Use of radial access for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has been increasing. We examined the clinical characteristics and procedural outcomes of patients who underwent CTO PCI with radial versus femoral access in the Prospective Global Registry for the Study of CTO Intervention (PROGRESS-CTO, NCT02061436). Of 10,954 patients who underwent CTO PCI at 55 centers in 7 countries between 2012 and 2022, 2578 (24%) had a radial only approach. Patients who underwent radial only access were younger (63 ± 10 vs. 65 ± 10, years, p < 0.001), more likely to be men (84% vs. 81%, p = 0.001), and had significantly lower prevalence of comorbidities compared with the femoral access group including diabetes mellitus (39% vs. 45%, p < 0.001) and coronary artery bypass graft surgery (57% vs. 64%, p < 0.001). In addition, radial only cases had lower angiographic complexity with lower J-CTO and PROGRESS-CTO scores. After adjusting for potential confounders, radial only access was associated with lower risk of access site complications (odds ratio [OR]: 0.45, 95% confidence interval [CI]: 0.22-0.91), similar technical success (OR: 0.87, 95% CI: 0.74-1.04) and major adverse cardiovascular events (MACE) (OR: 0.65, 95% CI: 0.40-1.07), compared with the femoral access group. Radial only access was used in 24% of CTO PCIs and was associated with lower access site complications, and similar technical success and MACE as compared with the femoral access group.

Keywords: chronic total occlusion; complications; femoral access; percutaneous coronary intervention; radial access.

MeSH terms

  • Aged
  • Chronic Disease
  • Clinical Studies as Topic
  • Coronary Angiography
  • Coronary Occlusion* / diagnostic imaging
  • Coronary Occlusion* / etiology
  • Coronary Occlusion* / therapy
  • Female
  • Humans
  • Male
  • Middle Aged
  • Multicenter Studies as Topic
  • Percutaneous Coronary Intervention* / adverse effects
  • Prospective Studies
  • Registries
  • Risk Factors
  • Treatment Outcome