Comparative efficacy and safety of the left versus right radial approach for percutaneous coronary procedures: a meta-analysis including 6870 patients

Abstract

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.

Effectiveness of a handmade “New Carotid Catheter” in transradial carotid angiography: A comparison with conventional multipurpose catheters

“…By shaping the catheters into spiral configurations, we decreased procedural time. 4,15,22,27,28 (Figure 2C)…”

“…In elderly patients, tortuosity further complicates the procedure. The use of 5F catheter in cases with tortuous subclavian arteries facilitates the application of this procedure …”

“…Since we used a 5 F diagnostic catheter and a 5 F sheath, our success in overcoming radial artery spasm and tortuosity was markedly increased relative to the use of 6 F catheters. By shaping the catheters into spiral configurations, we decreased procedural time . (Figure C)…”

Efficacy and Safety of "Coronary Artery Bypass Graft Angiography" with Right Transradial Access versus Left Transradial Access and Femoral Access: a Retrospective Comparative Study

“…After the course of aortography, we engaged the left subclavian angiography, due to the resemblance of the left radial tract to the femoral tract. Initial experience suggests that the left radial access is more advantageous than the right [3,11] .…”

“…In studies related to coronary angiography and percutaneous intervention that were conducted in recent years, transradial access has left its disadvantage in terms of time and performance relative to the transfemoral route, and advantageous in terms of complications [3][4][5] . Recently, radial access has been used for the purpose of carotid and renal artery angiography [6][7][8] , transradial access has been used for acute ischemic stroke intervention [9] , but femoral access is still advantageous from the point of view of the radiation exposure dose of the operator [10] .…”