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Comparison of transradial coronary procedures via right radial versus left radial artery approach: A meta-analysis
Rachit M Shah1, Dhavalkumar Patel1, Antonio Abbate1
1Department of Cardiology, Virginia Commonwealth University Hospital, Richmond, Virginia.
Insights
The left radial approach for coronary procedures may use slightly less contrast and fluoroscopy time compared to the right radial approach. Both methods show similar complication rates, making the choice operator-dependent.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Access
Background:
- Transradial approach for coronary angiography and angioplasty reduces access site complications.
- Operator preference often dictates the choice between right and left radial artery access due to limited comparative data.
Purpose of the Study:
- To compare the safety and efficacy of the right radial artery approach versus the left radial artery approach for coronary procedures.
- To analyze fluoroscopy time, procedure time, contrast use, and crossover rates in a meta-analysis of randomized studies.
Main Methods:
- A meta-analysis of 12 prospective randomized studies.
- Inclusion of 6,450 patients: 3,217 in the right radial approach group and 3,233 in the left radial approach group.
- Primary endpoints included fluoroscopy time, procedure time, contrast volume, and crossover rates.
Main Results:
- No significant difference in crossover rates (4.2% vs. 4.1%) or total procedure times (18.8 min vs. 18.1 min).
- The right radial approach was associated with slightly longer fluoroscopy times (5.8 min vs. 5.3 min) and greater contrast use (84 mL vs. 82 mL).
- Access site complications and stroke incidence were similar between both approaches.
Conclusions:
- The left radial approach may offer a minimal advantage in reduced contrast use and fluoroscopy time.
- Both right and left radial approaches demonstrate comparable safety profiles regarding procedural and access site complications.
- The choice between right and left radial artery access remains largely based on operator preference and patient-specific factors.
Introduction:
Coronary angiography and angioplasty via transradial approach is shown to be associated with significant reduction in access site complications. Due to a lack of sufficient data, the use of the right or left radial approach is still operator-dependent. We performed a meta-analysis of prospective randomized studies to compare right versus left radial artery approach for coronary procedures.
Methods:
We found 12 randomized studies meeting the predetermined inclusion criteria. A total of 6,450 patients were included in the meta-analysis of which 3,217 patients underwent coronary procedures via right radial approach and 3,233 patients via left radial approach. The primary endpoint was the comparison of fluoroscopy time, procedure time, contrast use and cross-over rates between two radial approaches.
Results:
Pooled analysis of the included studies showed a similar rate of cross-over events (4.2% for right radial approach vs. 4.1% for left radial approach, odds ratio (OR)=1.08, P = 0.68), and similar total procedure times (18.8 ± 10.3 min vs. 18.1 ± 10.0 min, standard difference (SD) of the mean = 0.09, P = 0.162) between the two radial approaches. However, the right radial approach was found to be associated with minimally longer fluoroscopy times (5.8 ± 4.4 min vs. 5.3 ± 4.2 min, SD of the mean = 0.157, P < 0.001) and greater contrast use (84 ± 35 mL vs. 82 ± 34 mL, SD of the mean = 0.082, P = 0.003). Access site complications and the incidence of stroke were similar between two radial approaches.
Conclusion:
Our meta-analysis suggests a small but statistically significant difference in terms of contrast use and fluoroscopy time in favor of coronary procedures performed via left radial approach in comparison to right radial approach without any significant difference in access site or other procedural complications between the two radial approaches. © 2016 Wiley Periodicals, Inc.
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