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Right versus left transradial approach for coronary catheterization in octogenarian patients
Xavier Freixa1, Marc Trilla, Matías Feldman
1Thorax Institute, Division of Cardiology, Interventional Cardiology Program, Hospital Clinic of Barcelona, Barcelona, Spain. freixa@clinic.ub.es
Insights
The left radial approach (LRA) is a viable alternative for coronary angiography in octogenarians. However, it did not show significant advantages over the right radial approach (RRA) regarding procedure or fluoroscopy times.
Area of Science:
- Cardiology
- Vascular Access Procedures
- Geriatric Cardiology
Background:
- Octogenarians face increased vascular access complications during invasive coronary catheterization.
- Transradial approach (TRA) is a safer alternative to reduce vascular complications.
- The comparative benefits of left radial approach (LRA) versus right radial approach (RRA) in elderly patients are not well-established.
Purpose of the Study:
- To evaluate if the left radial approach (LRA) offers advantages over the right radial approach (RRA) in octogenarian patients undergoing coronary diagnostic procedures.
- To compare procedural and fluoroscopy times between LRA and RRA in this patient group.
Main Methods:
- A randomized study involving 100 octogenarian patients undergoing transradial coronary angiography.
- Patients were randomized to either LRA (n=50) or RRA (n=50).
- Primary endpoints were procedural and fluoroscopy times; crossover rates and procedural difficulties were also assessed.
Main Results:
- Procedural and fluoroscopy times were similar between LRA and RRA groups.
- Subclavian tortuosity was more common on the right side (32% vs. 6%), but did not impact procedural outcomes.
- Crossover rates were low and not significantly different between the groups (10% for LRA vs. 4% for RRA).
Conclusions:
- The left radial approach (LRA) is a safe and valid alternative for diagnostic coronary procedures in octogenarian patients.
- LRA did not demonstrate a significant reduction in procedural or fluoroscopy times compared to the right radial approach (RRA).
- The choice between LRA and RRA may depend on individual patient anatomy and operator preference.
Objectives:
The aim of the study was to evaluate if the left radial approach (LRA) confers any additional advantage compared to the right radial approach (RRA) in octogenarian patients who undergo a coronary diagnostic procedure.
Background:
Octogenarians, an increasing segment of patients in our society, present a higher risk of access-site complications related to invasive coronary catheterization. Transradial approach has been shown to be an effective alternative to reduce vascular complications. Although some studies have suggested that elderly people might benefit from a LRA, the advantages of using the left or right radial access remain not clear.
Methods:
One hundred octogenarian patients undergoing a transradial coronary angiogram with normal Allen test and without previous history of coronary artery by-pass grafting were randomized to either LRA (n = 50) or RRA (n = 50). The primary end-points of the study were procedural and fluoroscopy times.
Results:
Mean age was 82.6 years (80-88) and 59% were males. Procedural and fluoroscopy times were similar among study groups. Crossover was required in two patients (4%) with RRA and five patients (10%) with LRA (P = 0.24). Subclavian tortuosity was more frequent in the right side (32% vs. 6% in the left side; P = 0.002) but this difference did not translate into longer procedural or fluoroscopy times or higher cross-over, procedural difficulty or wire manipulation.
Conclusions:
In our series of octogenarian patients, the LRA was a valid alternative for diagnostic procedures but its usage was not associated with a significant reduction in procedural and fluoroscopy times compared to the RRA.
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