Left Radial Access Is Preferable to Right Radial Access for the Diagnostic or Interventional Coronary Procedures: A Meta-Analysis Involving 22 Randomized Clinical Trials and 10287 Patients

Abstract

ObjectiveThe transradial approach has been used extensively for both diagnostic and interventional coronary procedures; however, there is no universal consensus hitherto on the optimal choice of radial access from either the left or the right artery. We therefore sought to meta-analyze available randomized clinical trials to compare the left with the right radial access for the diagnostic or interventional coronary procedures.Methods and ResultsFour electronic databases including the PubMed, EMBASE, Wanfang, and CNKI were searched up to April 2013. In total, there were 22 qualified randomized trials involving 5317 and 4970 patients assigned to the left and the right radial accesses, respectively. Data were extracted independently by two investigators. Analyses of the full data set indicated significant reductions in fluoroscopy time (seconds) (weighted mean difference; 95% confidence interval; P: −36.18; −53.28 to −18.53; <0.0005) and contrast use (mL) (−2.88; −5.41 to −0.34; 0.026) in patients with the left radial access compared to those with the right radial access, and there was strong evidence of heterogeneity but low probability of publication bias. The failure rate of radial access from the left was relatively lower than that from the right (odds ratio: 0.83; 95% confidence interval: 0.68−1.01; P = 0.064). Further in meta-regression analyses, body mass index was found to be a potential source of heterogeneity for both fluoroscopy time (regression coefficient: 35.85; P = 0.025) and catheter number (regression coefficient: 0.35; P = 0.018).ConclusionsOur findings demonstrate that left radial access is preferable to right radial access in terms of fluoroscopy time and contrast use for the diagnostic or interventional coronary procedures. The import of this study lies in its great shock to the concept of convenient radial access from the right artery.

Acute kidney injury after percutaneous coronary intervention: Rationale of the AKI‐MATRIX (acute kidney injury‐minimizing adverse hemorrhagic events by TRansradial access site and systemic implementation of angioX) sub‐study

“…These two latter definitions will be employed according to clinical data availability. Finally, we will assess the association between post‐procedural eosinophilia and AKI and whether a difference exists between left and right radial access in terms of reduced incidence of AKI and, in turn, whether it is mediated by a reduced amount of administered contrast with left radial access, as well as it has been extensively reported for fluoroscopy and procedural times .…”

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

“…Although a significant increase in operator radiation exposure with RR as compared to LR was shown, no significant differences were observed in fluoroscopy time, DAP values or Air-Kerma values. The fluoroscopy time was assessed in most studies, but conflicting results were reported; indeed, fluoroscopy time was increased with RR as compares to LR in 2 meta-analyses [30,31] whereas no significant increase was observed in another one [32].…”

“…Also when considering these parameters, published studies reported conflicting results (Table 3) although in the majority of them, including a meta-analysis [31], no significant differences were observed between LR and RR.…”

Ionizing radiation exposure in interventional cardiology: current radiation protection practice of invasive cardiology operators in Lithuania

“…In terms of the left and right radial access, strong evidence of heterogeneity is present among the published studies. Some authors report shorter fluoroscopy times in left radial access procedures and comparable DAP values between the two radial access routes [23]. However, these differences were not depicted by other propensity-matched cohorts, and no significant differences in median DAP values were observed, either for diagnostic or interventional procedures [24].…”