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Effectiveness of right or left radial approach for coronary angiography

Osamu Kawashima1, Norio Endoh, Masayoshi Terashima

  • 1Heart Center, Sendai Kosei Hospital, Sendai, Japan. uh9t-tsm@asahi-net.or.jp

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|February 28, 2004
PubMed

Insights

The left radial approach for coronary angiography offers improved procedural efficiency compared to the right radial approach, with shorter catheter manipulation and fluoroscopy times. This transradial catheterization technique may be preferred by experienced operators.

Area of Science:

  • Cardiovascular Interventions
  • Interventional Cardiology
  • Vascular Access

Background:

  • The transradial approach (TRA) is increasingly utilized for cardiac catheterization procedures.
  • Current selection of the radial artery (right vs. left) is typically based on operator preference.
  • Limited data exists on the comparative effectiveness of left versus right radial artery access for coronary angiography.

Purpose of the Study:

  • To investigate the influence of radial artery laterality on the effectiveness of coronary angiography.
  • To compare procedural outcomes between left radial artery access and right radial artery access.

Main Methods:

  • A comparative study involving 232 patients undergoing coronary angiography via the left radial approach and 205 patients via the right radial approach.
  • Utilized Judkins-type catheters for all procedures.
  • Key metrics assessed included access time, catheter manipulation duration, total procedural duration, fluoroscopy time, contrast volume, and guidewire usage.

Main Results:

  • No significant difference in arterial access time was observed between the left and right radial groups.
  • Shorter catheter manipulation duration (9.8 ± 4.4 min vs. 11.7 ± 5.9 min) and total procedural duration (11.4 ± 4.8 min vs. 13.7 ± 6.4 min) were noted in the left radial group (P < 0.001 for both).
  • Left radial approach resulted in significantly shorter fluoroscopy times (3.7 ± 2.5 min vs. 5.0 ± 3.3 min; P < 0.001) and reduced guidewire use (0/232 vs. 20/205; P < 0.001) due to right subclavian artery tortuosity.

Conclusions:

  • The left radial approach demonstrates superior procedural efficacy for coronary angiography compared to the right radial approach in experienced operators.
  • Shorter manipulation and fluoroscopy times associated with the left radial approach may lead to improved patient outcomes and reduced radiation exposure.
  • The anatomical challenges of the right subclavian artery may contribute to increased difficulty and guidewire use in the right radial approach.

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