Bilateral retrograde radial approach in stenting of occluded subclavian artery

Background: Transradial approach (TRA) is the preferred access site for PCI, but also it's gaining recognition in the peripheral interventions. There is insufficient published data regarding bilateral retrograde TRA in the stenting of patients with subclavian artery chronic total occlusion (CTO). Methods: We report 12 consecutive patients with symptomatic CTO of subclavian artery that underwent retrograde angioplasty from the ipsilateral TRA with contralateral control from the opposite TRA. Primary outcome was procedural success rate. Secondary outcomes were: presence of procedural complications, restenosis, MI, stroke or death and presence of any type of access site bleeding events. 6F guiding catheter JR 4.0 was most frequently used (n=11), for CTO coronary wire retrograde crossing of the occlusion and ballon predilatation. Exchange of wire was made with 0,035 guide wire. Balloon expandable stents were implanted solely through the short hydrophilic sheath, with contralateral contrast check. The average stent diameter was 6, 8 mm (range 5.0–8.0 mm), and the average stent length was 29, 1 mm (range 15-80 mm). One year clinical follow up and duplex ultrasonography was done in all patients. Results: All procedures were successfully done using contralateral injection strategy to confirm proper wire advancement within the lesion and optimal stent positioning. Minor access site bleeding complications were recorded in 4 patients. There were no other complications. Four patients were discharged the same day, the others one day after admission. At follow up only one patient had asymptomatic in stent re-occlusion documented 6 months after intervention. Conclusions: Our results suggest that bilateral radial access can be a successful strategy in opening of subclavian artery CTOs, with high procedural success and low rate in access site complications and procedural complications with the possibility of same day discharge.