Radial versus femoral access for coronary angiography and intervention is associated with lower patient radiation exposure in high-radial-volume centres: Insights from the RAY’ACT-1 study

Belle, Loïc; Meunier, Ludovic Le; Dechery, Thierry; Khalife, Khalifé; Pécheux, Max; El-Haddad, S.; Amabile, Nicolas; Pansiéri, Michel; Ballout, J.; Marchand, X.; Rouault, Gilles; Leddet, P.; Nugue, Olivier; Lucke, N.; Cattan, Simon

doi:10.1016/j.acvd.2016.09.002

Cited by 19 publications

(12 citation statements)

References 21 publications

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“…The RADIAL-CABG study compared transradial and transfemoral approaches in patients with a history of CABG and found longer procedural times and greater use of contrast agents with transradial procedures (13). This finding was supported by other trials and meta-analyses, as the radial approach has a steep learning curve and is technically more challenging, and is therefore associated with greater radiation exposure and use of contrast agents (14,15). Disadvantages of the radial approach, such as increased procedure time and contrast agent use, can be reduced by selection of a staged PCI strategy instead of ad hoc PCI in light of the present study.…”

Section: Discussionmentioning

confidence: 85%

Should We Use Staged or Ad-Hoc Approach in Percutaneous Coronary Interventions Through Radial Artery to Avoid Radial Artery Spasm?

Demir¹

2020

Erciyes Med J

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Objective: Transradial approach has recently been adopted as the default strategy for percutaneous coronary interventions due to benefits which include reduced all-cause mortality, major access-site complications, and hospital stay, as well as increased patient comfort and early ambulation. However, radial artery spasm (RAS) is still a major drawback. The impact on RAS of an ad hoc compared with a staged intervention strategy has not previously been investigated. In this study, we sought to investigate the effect of ad hoc and staged percutaneous coronary intervention (PCI) on RAS in patients undergoing elective transradial coronary interventions. Materials and Methods:In this retrospective study, patients with symptoms suggestive of ischemia who were scheduled for coronary angiography and candidates for elective PCI were enrolled and divided into two equal groups: ad hoc group and staged group. RAS was clinically identified and established based on the existence of two or more of predefined clinical features.Results: A total of 60 patients was enrolled in the study: 30 in the ad hoc group and 30 in the staged group. The mean time between coronary angiography and intervention in the staged group was 2.5 [1-30] days. RAS rates were similar between the ad hoc and staged PCI groups (16.7% [n=5] vs. 31% [n=9], p=0.233), but post-procedural pain was more frequent in patients in the ad hoc group (64.5% [n=20] vs. 33.3% [n=10], p=0.021). Radial artery occlusion did not differ between the ad hoc and staged PCI groups (10.7 % [n=3] vs. 11.1 [n=3], p=1). Conclusion:Use of ad hoc or staged strategies in patients undergoing transradial PCIs is not associated with reduced incidence of RAS. Post-procedural pain is more common in patients undergoing ad hoc PCI through radial artery.

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Section: Discussionmentioning

confidence: 85%

Should We Use Staged or Ad-Hoc Approach in Percutaneous Coronary Interventions Through Radial Artery to Avoid Radial Artery Spasm?

Demir¹

2020

Erciyes Med J

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“…Among the most significant advantages of radial compared to femoral access are the need for shorter hospitalization and fewer adverse effects (39). Though the present survey did not take into account patients' satisfaction and cost-effectiveness of radial angiography, these two variables have been investigated in many other studies, showing radial access superior to femoral access (20,(40)(41)(42)(43)(44)(45).…”

Section: Discussionmentioning

confidence: 94%

Comparison of X-Ray Duration and Contrast Agent Amount in Coronary Angiography Using Radial and Femoral Access in Bandar Abbas Angiography Center in 2017

Farshidi

Abdi

Khezri

et al. 2019

Hormozgan medical journal

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Background: In recent years, radial access has emerged as an alternative for femoral access in coronary arteries angiography. The former has the privilege of shorter hospitalization and fewer side effects, as compared to the latter. Objectives: The present survey aimed to compare the X-ray duration and contrast agent use between radial and femoral access sites. Methods: The present descriptive study was conducted with a convenience sample of 400 patients in 2017 in Bandar Abbas. The sample size was the same in the radial and femoral groups. Information such as age, sex, weight, angiography type and method, X-ray duration and amount of contrast agent was recorded. The collected data were statistically analyzed using SPSS-23. Results:The mean volume of the contrast agent was 44.74 ± 26.31 cc in the radial group and 28.77 ± 20.91 cc in the femoral group. The difference between the two groups was statistically significant (P < 0.001). The mean duration of X-ray was 383.66 ± 329.42 seconds in the radial group and 248.83 ± 225.72 seconds in the femoral group. The difference between the two groups was statistically significant (P < 0.001). Conclusions: Overall, the duration of X-ray and amount of contrast agent used in patients undergoing coronary angiography was higher in radial than in femoral access. This was more evident among patients who had only diagnostic angiography than those who undergone angiography and PCI at the same time.

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“…Moreover, Sciahbasi et al (20) concluded that radial approach was associated with higher operator and patient radiation exposure when performed by expert operators in patients with ACSs. In contrast, Georges et al (18, 19) stated that PCI via radial approach was associated with lower radiation exposure compared to femoral approach in high-radial-volume centers. They emphasized the importance of experience with regard to trans-radial angiography.…”

Section: Discussionmentioning

confidence: 97%

“…A meta-analysis by Plourde et al (17) also demonstrated an increased radiation exposure in the diagnostic CA arm of the study (17). On the other hand, Georges et al (18, 19) have stated that radial approach during diagnostic CA was associated with lower radiation exposure than femoral approach in high-radial-volume centers. A possible explanation for the similar radiation exposure observed in the diagnostic CA arm of this study (as compared to other studies that demonstrated a higher radiation exposure during diagnostic CA) is that a radial TIG catheter was used, instead of standard Judkins left-and-right catheters.…”

Section: Discussionmentioning

confidence: 99%

IS Trans-Radial Approach Related to an Increased RisK of RAdiation Exposure In Patients Who Underwent Diagnostic CoronaRY Angiography or Percutaneous Coronary Intervention? (The SAKARYA Study)

et al. 2019

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Objective: It is still debatable whether diagnostic coronary angiography (CA) or percutaneous coronary interventions (PCIs) increase radiation exposure when performed via radial approach as compared to femoral approach. This question was investigated in this study by comparison of dose-area product (DAP), reference air kerma (RAK), and fluoroscopy time (FT) among radial and femoral approaches. Methods: All coronary procedures between November 2015 and November 2017 were assessed; and 4215 coronary procedures were enrolled in the study. Patients with bifurcation, chronic total occlusion, cardiogenic shock, or prior coronary artery bypass surgery were excluded. These 4215 procedures were evaluated for three different categories: diagnostic CA (Group I), PCI in patients with stable angina (Group II), and PCI in patients with ACS (Group III). Results: Age was significantly higher in the femoral arm of all groups. Among patients in the radial arm of Groups I and II, males were over-represented. Therefore, a multiple linear regression analysis with stepwise method was performed. After adjusting these clinical confounders, there was no significant difference with regard to DAP, RAK, and FT between femoral and radial access in Group I. In contrast, PCI via radial access was significantly associated with increased DAP, RAK, and FT in Groups II and III. Conclusion: In spite of an increased experience with trans-radial approach, PCI of coronary lesions via radial route was associated with a relatively small but significant radiation exposure in our study. Compared to femoral access, diagnostic CA via radial access was not related to an increased radiation exposure.

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Radial versus femoral access for coronary angiography and intervention is associated with lower patient radiation exposure in high-radial-volume centres: Insights from the RAY’ACT-1 study

Abstract: In this multicentre study, radial access was associated with lower radiation doses to patient than femoral access in high-radial-volume centres. Provided that radioprotection methods are implemented, radial access could be associated with lower patient radiation exposure.

Cited by 19 publications

References 21 publications

Should We Use Staged or Ad-Hoc Approach in Percutaneous Coronary Interventions Through Radial Artery to Avoid Radial Artery Spasm?

Should We Use Staged or Ad-Hoc Approach in Percutaneous Coronary Interventions Through Radial Artery to Avoid Radial Artery Spasm?

Comparison of X-Ray Duration and Contrast Agent Amount in Coronary Angiography Using Radial and Femoral Access in Bandar Abbas Angiography Center in 2017

IS Trans-Radial Approach Related to an Increased RisK of RAdiation Exposure In Patients Who Underwent Diagnostic CoronaRY Angiography or Percutaneous Coronary Intervention? (The SAKARYA Study)

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