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[A meta-analysis of randomized controlled trials comparing left with right radial approach for coronary angiography]
Xiaowei Niu1, Cuiling Yang, Shengliang He
1First Clinical Medical College of Lanzhou University, Lanzhou 730000, China.
Insights
The left radial approach (LRA) for coronary angiography (CAG) is as safe as the right radial approach (RRA). LRA reduces fluoroscopy time and subclavian artery tortuosity, making it a viable alternative for CAG procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Coronary angiography (CAG) is a key diagnostic procedure.
- The choice of radial artery access (left vs. right) can impact procedure outcomes.
- Optimizing safety and efficiency in CAG is crucial for patient care.
Purpose of the Study:
- To systematically compare the efficacy and safety of the left radial approach (LRA) versus the right radial approach (RRA) for CAG.
- To evaluate procedural success rates, contrast medium usage, fluoroscopy time, and vascular complications.
- To determine if LRA offers advantages over RRA in specific clinical scenarios.
Main Methods:
- A systematic review and meta-analysis of published trials.
- Databases searched included PubMed, Embase, Web of Science, Cochrane Library, CBM, VIP, Wanfang, and CNKI up to January 2013.
- Data extraction and statistical analysis were performed independently by two reviewers using Review Manager Software (RevMan 5.1).
Main Results:
- Eleven trials involving 5,442 patients were analyzed.
- LRA showed no significant difference in procedural failure rate or contrast medium volume compared to RRA.
- LRA significantly reduced fluoroscopy time (P < 0.01) and the incidence of severe subclavian artery tortuosity (P < 0.01) compared to RRA.
Conclusions:
- LRA demonstrates comparable safety to RRA for CAG.
- LRA offers superior outcomes in terms of reduced fluoroscopy time and lower rates of subclavian artery tortuosity.
- LRA can be considered a safe and effective alternative or routine approach for performing CAG.
Objective:
To compare the efficacy between left radial approach (LRA) and right radial approach (RRA) for coronary angiography (CAG).
Methods:
The following databases were searched, including PubMed, Embase, Web of science, Cochrane Library, CBM, VIP, Wanfang databases and CNKI, from creation of database to January 2013. Two reviewers extracted data independently, according to inclusive criteria, exclusion criteria and methods of Cochrane Collaboration. Statistical analysis was performed using Review Manager Software (RevMan 5.1).
Results:
Eleven trials with 5 442 patients were included in the systematic review. The results of meta-analysis showed that when compared with RRA, LRA did not increase the failure rate of the procedures (OR = 1.04, 95%CI 0.80-1.35, P > 0.05) and amount of contrast medium (mean difference = 2.39, 95%CI -0.30-5.08), P > 0.05). However, LRA was superior to RRA in reducing fluoroscopy time (standardized mean difference = 0.15, 95%CI 0.06-0.24, P < 0.01). In addition, the incidence of severe tortuosity of subclavian artery was significantly lower with LRA (OR = 4.65, 95%CI 1.98-10.88, P < 0.01).
Conclusions:
Based on the current evidence, LRA shares similar safety with RRA for CAG and is superior to RRA in certain respects. LRA can thus be used either as an alternative approach or routine approach for CAG.
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