Radial versus femoral approach in chronic total occlusion percutaneous coronary intervention: A systematic review and meta-analysis

Background: Radial approach (RA) is increasingly used in chronic total occlusion percutaneous coronary intervention (CTO PCI) with encouraging results. However, there are concerns about its safety and efficacy given higher complexity and need for strong guide catheter support. Methods: We performed a systematic review and meta-analysis of all studies published through November 2018 reporting the outcomes of RA vs. femoral approach (FA) in CTO PCI. Outcomes included technical success, major bleeding, access site complications, and in-hospital major adverse events. Results: Nine observational studies with 10,590 patients (10,617 lesions) were included in the meta-analysis. There was no difference in technical success between RA and FA [78.7% vs. 78.5%, OR: 1.11, 95% CI (0.94, 1.31), p = 0.24, I2 = 23%]. The RA was associated with a lower risk of access-site complications [0.73% vs. 1.79%, OR: 0.34, 95% CI (0.22, 0.51), p \u3c 0.001, I2 = 0%] and major bleeding [0.18% vs. 0.9%, OR: 0.22, 95% CI (0.10, 0.45), p \u3c 0.001, I2 = 0%) compared with FA. The RA was associated with a similar risk of in-hospital adverse events and a numerically lower risk of in-hospital mortality [OR: 0.36, 95% CI (0.12- 1.07), p = 0.07, I2 = 0%] compared with FA. Conclusions: Our meta-analysis demonstrates encouraging outcomes with the radial approach in CTO PCI, supporting its increasing use in this setting. (Table Presented)