Transradial versus transfemoral method of two-stent implantation for true bifurcation lesions: comparison of immediate and long-term outcomes.

Background: The feasibility, safety, and efficacy of two-stent implantation for true bifurcation disease through transradial (TR) versus transfemoral (TF) approaches have not been thoroughly investigated.

Methods And Results: We compared procedural and long-term outcomes of a two-stent strategy percutaneous revascularization in 805 consecutive patients with true bifurcation lesions requiring two-stent implantation via either a TR (n = 508) or TF (n = 297) approach from 2004 to 2009. Clinical and angiographic characteristics, procedural outcomes, and in-hospital and long-term clinical events were compared according to vascular access strategy. Using logistic regression to derive a propensity score model, 249 matched patient pairs were compared. The demographic, angiographic, and procedural characteristics were similar between groups, with the exception of less prior percutaneous intervention and left main bifurcation or multivessel disease in the TR group (all P < 0.05). Angiographic success and fluoroscopy time were similar between cohorts. The duration of hospitalization and in-hospital occurrence of Bleeding Academic Research Consortium defined bleeding (3.9% vs. 9.1%, P < 0.01) were significantly lower in the TR group. During a mean follow-up period of 55 ± 22 months, in a multivariate regression analysis, the TR method was not predictive of major adverse cardiac events (adjusted hazards ratio [HR]: 1.33, 95% confidence interval [CI]: 0.83-2.14), cardiac death, myocardial infarction, target vessel revascularization (HR: 0.93, 95% CI: 0.45-1.93), or stent thrombosis.

Conclusion: In comparison to TF vascular access, two-stent implantation via TR approach for true bifurcation lesions is associated with similar in-hospital outcomes, shorter hospitalization, reduced bleeding, and comparable long-term clinical safety and efficacy.