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Right versus left radial artery access for coronary procedures: an international collaborative systematic review and
Giuseppe Biondi-Zoccai1, Alessandro Sciahbasi, Vicente Bodí
1Division of Cardiology, University of Modena and Reggio Emilia, Modena, Italy. gbiondizoccai@gmail.com
Insights
For coronary procedures, right and left radial artery access show similar outcomes. However, left radial access may be preferable during initial learning phases to reduce the need for femoral artery crossover.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Access
Background:
- Radial artery access is a standard approach for diagnosing and treating coronary artery disease.
- Uncertainty exists regarding the comparative efficacy of right versus left radial artery access for coronary procedures.
Purpose of the Study:
- To systematically review and meta-analyze studies comparing right versus left radial artery access for coronary diagnostic and interventional procedures.
Main Methods:
- A systematic search of CENTRAL, Google Scholar, MEDLINE/PubMed, and Scopus was conducted.
- Included randomized trials compared right versus left radial (or ulnar) access.
- Risk ratios and weighted mean differences were calculated for outcomes.
Main Results:
- Five trials with 3210 patients were analyzed.
- No significant differences were observed in procedural time, contrast use, fluoroscopy time, or major complications.
- Right radial access showed a significantly higher risk of failure and crossover to femoral access compared to left radial access.
Conclusions:
- Right and left radial artery accesses demonstrate comparable procedural and clinical performance in transradial procedures.
- Left radial access is recommended, particularly during the learning curve, to minimize femoral artery crossovers.
Background:
Radial artery access is a mainstay in the diagnosis and treatment of coronary artery disease. However, there is uncertainty on the comparison of right versus left radial access for coronary procedures. We thus undertook a systematic review and meta-analysis comparing right versus left radial access for coronary diagnostic and interventional procedures.
Methods:
Pertinent studies were searched in CENTRAL, Google Scholar, MEDLINE/PubMed, and Scopus, together with international conference proceedings. Randomized trials comparing right versus left radial (or ulnar) access for coronary diagnostic or interventional procedures were included. Risk ratios (RR) and weighted mean differences (WMD) were computed to generate point estimates (95% confidence intervals).
Results:
A total of 5 trials (3210 patients) were included. No overall significant differences were found comparing right versus left radial access in terms of procedural time (WMD=0.99 [-0.53; 2.51]min, p=0.20), contrast use (WMD=1.71 [-1.32; 4.74]mL, p=0.27), fluoroscopy time (WMD=-35.79 [-3.54; 75.12]s, p=0.07) or any major complication (RR=2.00 [0.75; 5.31], p=0.49). However, right radial access was fraught with a significantly higher risk of failure leading to cross-over to femoral access (RR=1.65 [1.18; 2.30], p=0.003) in comparison to left radial access.
Conclusions:
Right and left radial accesses appear largely similar in their overall procedural and clinical performance during transradial diagnostic or interventional procedures. Nonetheless, left radial access can be recommended especially during the learning curve phase to reduce femoral cross-overs.
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