CARPOOL Study Compares Radial and Femoral Access for PAD Treatment

May 6, 2026—In the CARPOOL study, radial-to-peripheral (R2P) access achieved procedural success rates comparable to traditional common femoral artery (CFA) access for lower extremity peripheral artery disease (PAD) revascularization. However, 6-month major adverse limb events (MALE)—a composite of all-cause mortality, target vessel revascularization (TVR), and major amputations—were higher in the R2P group, predominantly driven by TVR.

The CARPOOL findings were presented as late-breaking clinical science at SCAI 2026, the Society for Cardiovascular Angiography & Interventions scientific sessions.

According to the SCAI press release, investigators in the real-world, retrospective study used data from the multicenter, core laboratory–adjudicated XLPAD registry to propensity match consecutive R2P procedures to CFA cases, adjusting for demographics, cardiovascular risk, and clinical presentation.

The study was composed of 546 patients. Approximately half of the lesions were chronic total occlusions. Mean lesion length was greater in the CFA group versus the R2P group. The use of stents (56%) and drug-coated balloons (29%) was similar in both groups.

As summarized in the SCAI press release, the CARPOOL investigators used a multivariable Cox proportional hazards model. The study demonstrated that procedural success was higher in the CFA group compared to the R2P group (95% vs 87%), but R2P remained clinically noninferior (P = .001; prespecified margin of 15%).

In the primary endpoint, the incidence of MALE at 6 months was higher in the R2P group versus the CFA group (15.8% vs 8.1%; hazard ratio, 1.99; 95% CI, 1.19-3.35; P = .006), mainly caused by TVR (11.7% vs 5.1%; P = .006). The rates of death (3.3%) and major amputation (1.1%) were similar between the two groups.

Sameh Sayfo, MD, an interventional cardiologist at Baylor Scott & White The Heart Hospital in Plano, Texas, commented on the findings in the SCAI press release.

“With proper training, experience, and the right equipment, many patients can be safely and effectively treated by a transradial approach to treat their PAD,” stated Dr. Sayfo. “In addition to procedural safety, this approach shortens hospital stays and makes bleeding complications easier to manage. Continued research and device innovation will be important to advance the technique further.”

Dr. Sayfo added, “We hope these findings help inform future randomized trials and ultimately contribute to meaningful changes in clinical guidelines for peripheral arterial interventions.”