Patient radiation exposure in right versus left trans-radial approach for coronary procedures

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Imaging

Background:

• The left trans-radial approach (LR) offers a catheter course similar to the trans-femoral approach, potentially simplifying coronary ostia negotiation.
• This could theoretically lead to reduced fluoroscopy time (FT) and radiation exposure compared to the right trans-radial approach (RR).

Purpose of the Study:

• To compare radiation exposure, measured by dose-area product (DAP), between the right trans-radial (RR) and left trans-radial (LR) approaches for coronary procedures.
• To evaluate differences in fluoroscopy time (FT) and contrast volume (CV) between the two radial approaches.

Main Methods:

• Retrospective analysis of 1464 diagnostic and interventional coronary procedures (PCI) performed between May 2009 and May 2014.
• Inclusion criteria required available dose-area product (DAP) values.
• Propensity score matching was used to create comparable cohorts for LR and RR groups.

Main Results:

• Median DAP values were initially higher in RR compared to LR for both diagnostic and interventional procedures (p < 0.05).
• However, in the propensity-matched cohort (269 procedures per group), no significant differences in median DAP, FT, or contrast volume (CV) were observed between LR and RR.
• Multiple linear regression analysis indicated that the laterality of the trans-radial approach was not associated with DAP.

Conclusions:

• In centers with extensive experience in trans-radial procedures, the left radial approach (LR) does not offer a significant reduction in radiation exposure (DAP) compared to the right radial approach (RR).
• Fluoroscopy time (FT) and contrast volume (CV) were also found to be similar between the LR and RR groups.