Immediate Results of Percutaneous Coronary Intervention for Unprotected Left Main Coronary Artery Stenoses: Transradial versus Transfemoral Approach

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 transradialapproach with that of a transfemoral approach for unprotected leftmain coronary artery (ULMCA) stenoses. We compared success rate, vascularcomplications and early (in-hospital and six-month) outcomes of transradialPCI for ULMCA stenoses with those of a transfemoral approach.Methods: This retrospective study included 131 patients undergoing PCI for ULMCAstenoses between December 2000 and October 2006: 116 (88.5%) patientsunderwent a transradial approach and fifteen (11.5%) underwent a transfemoralapproach.Results: Both angiographic and procedural success were achieved in 114 (98.3%)patients in the transradial group and fourteen (93.3%) patients in the transfemoralgroup (p = 0.876). Patients in the transfemoral group required moredebulking procedures with large guiding catheters and had larger minimalluminal 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 ratecompared to the transfemoral approach (1.7% vs. 26.6%, p < 0.001). SixmonthMACE was lower in the transradial group than the transfemoral groupwithout statistical significance (8.0% vs. 23.1%, p = 0.299).Conclusions: A transradial approach for ULMCA diseases produced an equal success rateand a lower vascular complication rate when compared to a transfemoralapproach. It should be considered as an acceptable alternative to the transfemoralapproach for PCI in ULMCA diseases.