Left vs. right radial approach for coronary catheterization: Relation to age and severe aortic stenosis
Maximilian Will1,2, Thomas W Weiss2,3, Michael Weber4
1Department of Internal Medicine 3, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, Krems, Austria.
Insights
The left radial artery approach (LRA) offers higher success rates for coronary angiography in elderly patients (≥85 years) and those with severe aortic stenosis compared to the right radial artery approach (RRA). This method also reduces contrast and fluoroscopy times.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Vascular Access
Background:
- Advancing age and aortic stenosis can alter aortic anatomy, potentially complicating catheter navigation.
- Traditional catheterization approaches may face increased challenges in elderly patients with aortic stenosis.
Purpose of the Study:
- To determine if increasing age or severe aortic stenosis impacts catheterization success rates between left radial artery approach (LRA) and right radial artery approach (RRA).
Main Methods:
- A retrospective analysis of 21,259 coronary angiographies was conducted.
- Success rates were compared between LRA and RRA across different age groups and in patients with severe aortic stenosis.
Main Results:
- First-pass success rates decreased with increasing age for both approaches.
- In patients aged ≥85 years, LRA demonstrated significantly higher success rates (90.1%) than RRA (82.8%).
- Patients ≥85 years using LRA experienced reduced contrast agent volume and shorter fluoroscopy times.
- LRA also showed superior first-pass success rates (91.9%) compared to RRA (85.1%) in patients with severe aortic stenosis.
Conclusions:
- The left radial artery approach (LRA) is associated with superior first-pass catheter success rates for coronary angiography in elderly patients (≥85 years) and those with severe aortic stenosis.
- LRA offers potential benefits in terms of reduced radiation exposure and contrast media usage in these specific patient populations.
Background:
Old age and the presence of aortic stenosis are associated with the unfolding of the intrathoracic aorta. This may result in increased difficulties navigating catheters from the right compared to the left radial approach.
Objective:
To investigate whether increasing age or presence of severe aortic stenosis was associated with increased catheterization success rates from left (LRA) compared to right radial artery approach (RRA).
Methods:
We compared coronary angiography success rates of RRA and LRA according to different age groups and in a subgroup of patients with severe aortic stenosis.
Results:
A total of 21,259 coronary angiographies were evaluated. With increasing age, the first pass success rate from either radial access decreased significantly (p < 0.001). In patients aged <85 years, there was no difference between LRA and RRA. However, in patients aged ≥85 years, LRA was associated with significantly higher success rates compared to RRA (90.1 vs. 82.8%, p = 0.003). Patients aged ≥85 years received less contrast agent and had shorter fluoroscopy time when LRA was used [86.6 ± 41.1 vs. 99.6 ± 48.7 ml (p < 0.001) and 4.5 ± 4.1 min vs. 6.2 ± 5.7 min (p < 0.001), mean (±SD)]. In patients with severe aortic stenosis (n = 589) better first pass success rates were observed via LRA compared to the RRA route (91.9 vs. 85.1%, p = 0.037).
Conclusion:
LRA, compared to RRA, is associated with a higher first-pass catheter success rate for coronary artery angiography in patients aged ≥85 years and those with severe aortic stenosis.
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