Vascular Access-Site Complications in Chronic Total Occlusion Percutaneous Coronary Intervention
Recommended Citation
Alexandrou M, Strepkos D, Carvalho PEP, Mutlu D, Ser OS, Alaswad K, Basir MB, Khelimskii D, Krestyaninov O, Khatri JJ, Young L, Goktekin O, Poommipanit P, Jaffer FA, Gorgulu S, Azzalini L, Ozdemir R, Uluganyan M, Raj LM, Mastrodemos O, Sara JS, Rangan BV, Jalli S, Voudris KV, Sandoval Y, Burke MN, and Brilakis ES. Vascular Access-Site Complications in Chronic Total Occlusion Percutaneous Coronary Intervention. Catheter Cardiovasc Interv 2025.
Document Type
Article
Publication Date
3-17-2025
Publication Title
Catheterization and cardiovascular interventions
Abstract
BACKGROUND: Vascular access-site complications (VASC) can occur during chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
METHODS: We compared the baseline and procedural characteristics, and outcomes of patients with versus without VASC in a large multicenter CTO PCI registry. VASC was defined as any of the following: small hematoma (hematoma < 5 cm), large hematoma (hematoma ≥ 5 cm), arteriovenous fistula, pseudoaneurysm and acute arterial closure.
RESULTS: VASC occurred in 158 of 16,810 CTO PCIs (0.9%). VASC patients were older (67 ± 11 vs. 64 ± 10 years, p < 0.001), more likely to be women (28.4% vs. 19.1%, p = 0.004) and less likely to be current smokers (18.9% vs. 27.2%, p = 0.026). They were more likely to have at least one femoral access (89.2% vs. 75.3%, p < 0.001) and less likely to have any radial access (38.0% vs. 52.3%, p < 0.001). Transfemoral access was more common in patients with VASC (60.1% vs. 45.7%, p < 0.001). VASC cases had higher J-CTO (2.57 vs. 2.38, p = 0.05) and PROGRESS-CTO major adverse cardiac events (MACE) scores (3.27 vs. 2.58, p < 0.001). They had similar technical (87.3% vs. 87.1%, p > 0.9) and procedural (82.3% vs. 85.9%, p = 0.2) success, but higher MACE (6.3% vs. 1.9%, p < 0.001) and bleeding (23.4% vs. 0.4%, p < 0.001). Female gender (odds ratio [OR] 1.95, 95% confidence intervals [CI] 1.24-3.00, p = 0.003), at least one femoral access (OR 2.02, 95% CI 1.09-4.04, p = 0.034) and sheath size (7-F: OR 2.16, 95% CI 1.12-4.60, p = 0.031; 8-F: OR 2.11, 95% CI 1.03-4.70,p = 0.051) were associated with VASC in multivariable analysis.
CONCLUSION: Female sex, femoral access and larger sheaths ≥ 7 F were associated with VASC in patients undergoing CTO PCI.
PubMed ID
40095762
ePublication
ePub ahead of print
