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Left radial access for percutaneous coronary procedures: from neglected to performer? A meta-analysis of 14 studies
Salvatore De Rosa1, Daniele Torella1, Gianluca Caiazzo1
1Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.
Insights
Left radial artery access for percutaneous coronary interventions offers reduced contrast medium, fluoroscopy time, and procedural duration compared to the right radial approach. Procedural failure rates remain similar between both radial artery access routes.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Vascular Access
Background:
- Radial artery access is the preferred route for percutaneous coronary procedures due to its safety profile.
- Historically, the right radial artery was favored, but left radial access is hypothesized to offer advantages.
- Favorable vascular anatomy of the left radial artery may improve procedural outcomes.
Purpose of the Study:
- To compare the procedural performance of left versus right radial artery access for percutaneous coronary interventions.
- To evaluate differences in contrast utilization, fluoroscopy time, procedural duration, and failure rates.
- To provide evidence-based insights into optimizing radial artery selection for interventional cardiology procedures.
Main Methods:
- A meta-analysis of 14 studies involving 7603 procedures was conducted.
- Comparative analysis of right radial access versus left radial access.
- Statistical methods included corrected standardized mean difference (Hedges' g) and odds ratios (OR).
Main Results:
- Left radial access was associated with significantly less contrast medium used (p=0.007).
- Reduced fluoroscopy time (p=0.001) and total procedural time (p<0.001) were observed with left radial access.
- No statistically significant difference in procedural failure rates was found between left and right radial access (p=0.942).
Conclusions:
- Left radial artery access demonstrates a modest but significant reduction in key procedural metrics.
- The choice between left and right radial access does not impact procedural failure rates.
- Left radial access may be a more efficient approach for percutaneous coronary interventions.
Background:
Radial artery is currently the preferred access route for percutaneous coronary procedures. The major reason for its widespread use is the higher safety as compared to femoral artery access. Initially most centers have preferred the right radial artery. However, an advantage has been hypothesized for the left radial access especially for the more favorable vascular anatomy. For this reason, the aim of the present meta-analysis was to compare procedural performance of left and right radial artery access for percutaneous coronary interventions.
Methods:
We performed a meta-analysis of all available studies comparing right radial access and left radial access for coronary procedures. Corrected standardized mean difference (Hedges' g) and odds ratios (OR) were used to estimate the mean effect respectively for continuous variables and frequencies.
Results:
The present analysis includes 14 studies with 7603 procedures. A statistically significant difference in the amount of contrast medium utilized for the procedure (0.12 [0.03-0.21], p=0.007), in fluoroscopy time (0.16 [0.06-0.25], p=0.001) and in total procedural time (0.22 [0.11; 0.33], p<0.001) was observed in favor of the left radial access. At the same time, no significant difference in the rate of procedural failure was observed between the right and the left radial access routes (OR=1.01 [0.70-1.47], p=0.942).
Conclusions:
Left radial access is associated to a modest yet significant reduction in fluoroscopy time, procedural time and in the amount of contrast medium administered, while failure rate was similar between right and left radial approaches.
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