NEW YORK (Reuters Health) – Percutaneous revascularization of the left main coronary artery can be performed via the transradial approach, with success rates similar to transfemoral access, according a study conducted in China.

Furthermore, hospitalization is shortened and bleeding complications reduced, Dr. Yue-Jin Yang, with the Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, and colleagues report in the October issue of JACC: Cardiovascular Interventions.

Their aim was to compare outcomes between transradial (TR) and transfemoral (TF) percutaneous coronary intervention (PCI) with drug-eluting stents in unprotected left main coronary artery (UPLM) disease.

As the authors note in their paper, “Considering the practical limitations associated with TR PCI in high-risk lesion anatomy (e.g., guiding catheter support, equipment size restrictions), UPLM disease challenges the feasibility of a transradial procedural strategy compared with a more standard femoral approach.”

The study involved 821 consecutive patients with UPLM disease who underwent percutaneous revascularization by either transradial access (n = 353) or the transfemoral approach (n = 468).

In the two groups, procedural success rates were 97% and 96%, respectively (p=0.57), and total procedural times were 61.6 and 62.7 minutes (p=0.13). However, the volume of contrast used was significantly less at 311 vs. 320 mL (p=0.02), Dr. Yang and colleagues report. Also, the combined rate of major and minor bleeding was 0.6% and 2.8% in the TR and TF groups, respectively (p=0.02).

When the investigators matched a subgroup of 254 patients from each group by propensity score, they found no statistically significant difference in adverse outcomes over a mean follow-up of 17 months. Specifically, in the TR vs TF groups, rates of cardiovascular death were 1.2% vs. 2.0%, respectively, nonfatal MI occurred in 4.7% vs. 2.4%, and target-vessel revascularization was necessary in 6.0% vs. 6.7%.

“These results not only inform our understanding of TR PCI regarding the procedural challenges involved in the treatment of more complex and high-risk coronary anatomy, but also add to the evidence basis associating TR PCI with reduced bleeding events and resource use,” Dr. Yang and colleagues conclude.

J Am Coll Cardiol Intv 2010;3:1035-1042.