The left radial approach in daily practice. A randomized study comparing femoral and right and left radial approaches

The right radial (RR) approach has been incorporated into daily clinical practice as a valid alternative to the femoral (F) approach. The left radial (LR) approach is seldom used and few data are available from randomized studies comparing this approach with F and RR approaches.

We randomized 1005 consecutive patients referred to a tertiary-care hospital for cardiac catheterization to different approaches. Procedures were performed by three interventional cardiologists experienced in transradial catheterization. There were no exclusion criteria. The primary end-point was the percentage of procedures completed using the assigned approach. Secondary endpoints were the percentage completed in the absence of contraindications to any approach, the duration of the procedure, and the incidence of vascular complications.

More procedures were completed with the F approach (LR, 71%; F, 92%; RR, 68%; P< .001). The success rate in the absence of contraindications to any approach (n=907) was greater with the F approach, with no difference between LR and RR approaches (LR, 80%; F, 96%; RR, 82%; P< .001). The canalization time was greater with the LR approach (P< .001), the time required for diagnosis was shorter with the F approach (P< .001) and compression was faster with the radial approach (P< .001). There was no difference in the total duration of diagnostic procedures (P=.22) or interventions (P=.9). The incidence of vascular complications was lower with the radial approach (P=.03).

The left radial approach is as valid an alternative to the femoral approach as the right radial approach.