The radial approach is widely used in the treatment of patients with coronary artery
disease. We conducted a meta-analysis of published results on the efficacy and safety
of the left and right radial approaches in patients undergoing percutaneous coronary
procedures. A systematic search of reference databases was conducted, and data from
14 randomized controlled trials involving 6870 participants were analyzed. The left
radial approach was associated with significant reductions in fluoroscopy time
[standardized mean difference (SMD)=-0.14, 95% confidence interval (CI)=-0.19 to
-0.09; P<0.00001] and contrast volume (SMD=-0.07, 95%CI=-0.12 to -0.02; P=0.009).
There were no significant differences in rate of procedural failure of the left and
the right radial approaches [risk ratios (RR)=0.98; 95%CI=0.77-1.25; P=0.88] or
procedural time (SMD=-0.05, 95%CI=0.17-0.06; P=0.38). Tortuosity of the subclavian
artery (RR=0.27, 95%CI=0.14-0.50; P<0.0001) was reported more frequently with the
right radial approach. A greater number of catheters were used with the left than
with the right radial approach (SMD=0.25, 95%CI=0.04-0.46; P=0.02). We conclude that
the left radial approach is as safe as the right radial approach, and that the left
radial approach should be recommended for use in percutaneous coronary procedures,
especially in percutaneous coronary angiograms.
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