Immediate results of percutaneous coronary intervention for unprotected left main coronary artery stenoses: transradial versus transfemoral approach

Shu-Kai Hsueh, Yuan-Kai Hsieh, Chiung-Jen Wu, Chih-Yuan Fang, Ali A Youssef, Chien-Jen Chen, Shyh-Ming Chen, Cheng-Hsu Yang, Hon-Kan Yip, Mien-Cheng Chen, Morgan Fu, Cheng-I Cheng
Chang Gung Medical Journal 2008, 31 (2): 190-200

BACKGROUND: The effectiveness of a transradial approach for percutaneous coronary intervention (PCI) is comparable to that of a transfemoral approach. However, few studies have systematically compared the clinical effectiveness of a transradial approach with that of a transfemoral approach for unprotected left main coronary artery (ULMCA) stenoses. We compared success rate, vascular complications and early (in-hospital and six-month) outcomes of transradial PCI for ULMCA stenoses with those of a transfemoral approach.

METHODS: This retrospective study included 131 patients undergoing PCI for ULMCA stenoses between December 2000 and October 2006: 116 (88.5%) patients underwent a transradial approach and fifteen (11.5%) underwent a transfemoral approach.

RESULTS: Both angiographic and procedural success were achieved in 114 (98.3%) patients in the transradial group and fourteen (93.3%) patients in the transfemoral group (p = 0.876). Patients in the transfemoral group required more debulking procedures with large guiding catheters and had larger minimal luminal diameter following PCI than those in the transradial group. Transradial PCI produced fewer in-hospital major adverse cardiac events (MACE) (7.8% vs. 33.3%, p = 0.003) and a lower vascular complication rate compared to the transfemoral approach (1.7% vs. 26.6%, p < 0.001). Six-month MACE was lower in the transradial group than the transfemoral group without statistical significance (8.0% vs. 23.1%, p = 0.299).

CONCLUSIONS: A transradial approach for ULMCA diseases produced an equal success rate and a lower vascular complication rate when compared to a transfemoral approach. It should be considered as an acceptable alternative to the transfemoral approach for PCI in ULMCA diseases.

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