Transradial approach (left vs right) and procedural times during percutaneous coronary procedures: TALENT study

Best practices for transradial angiography and intervention: A consensus statement from the society for cardiovascular angiography and intervention's transradial working group

“…Finally, a small study examining the use of a lead-free radiation shield over the right radial sheath insertion site showed a 13-34% reduction in operator radiation exposure [16]. Another issue to consider is the routine use of the left radial artery, which is associated with shorter procedure times, particularly among patients over the age of 75 years and those with short stature [17]. The most important predictor of both patient and operator radiation exposure with radial approach may be operator proficiency.…”

“…6. Femoral access sites should be prepared routinely in patients with STEMI when the operator is early in their experience with transradial primary PCI or when the need for adjunctive devices like intraaortic balloon counterpulsation is anticipated General measures Increase distance from image intensifier Use low intensity fluoroscopy and low-frame rate for cine acquisitions whenever possible Utilize standard shielding (lead gown/vest, drape, lead shield, thyroid collar) Specific measures for transradial procedures Use of a radial-specific radiation drape [16] Use of a radiation board [15] Avoid routine fluoroscopy/cineangiography of upper arm Utilization of the left radial approach [13,17] Under table leaded flaps The use of radial access for primary PCI in STEMI potentially affords the greatest opportunity to improve outcomes compared to femoral access. Patients presenting with STEMI are frequently placed on aggressive anticoagulant and anti-platelet therapies that increase their risk of vascular access site complications.…”

Transradial Approach for Coronary Interventions: The New Gold Standard for Vascular Access?

“…As mentioned before, a recent randomized trial, designed to evaluate safety and efficacy of left radial approach compared with right radial approach for coronary diagnostic and interventional procedures, showed that the left side was associated with slight but significantly lower fluoroscopy time and radiation dose adsorbed by patients. The left radial access advantages were particularly seen in older patients and for operators in training (66). These results are encouraging and future trials may further explore the potential advantages of a systemati c l e f t r a d i a l a p p r o a c h w i t h t h e u s e o f dedicated radial catheters to reduce the amount of fluoroscopy and finally the gap with femoral approach in terms of radiation exposure.…”

“…In most centers, transradial coronary interventions are performed through the right radial artery, because this side offers a more comfortable working position for the operator, but on a technical point of view there is some evidence that catheter manipulation could be easier by a left-sided approach, because of similar sensations compared to a femoral way and perhaps offering more back-up support for guiding catheters. In the TALENT study, a randomized comparison of right versus left radial approach for diagnostic procedures, the left approach was associated with lower fluoroscopy time and radiation dose, reflecting an easier procedure, particularly in older patients (> 70 years) and for operators in training (66). The absence of a radial artery pulse or a negative Modified Allen's Test on one side, as well as the need to selectively cannulate a mammary bypass graft also frequently influence the choice.…”

Twelve-month clinical outcomes of transradial coronary artery intervention: comparison of the right and left radial artery approach

“…This was demonstrated by the TALENT (Left Versus Right Transradial Approach for Percutaneous Coronary Procedures) trial, which randomised nearly 1500 patients undergoing transradial coronary angiography with either right or left radial routes. The study found that among trainees, the left radial approach was associated with a significantly shorter learning curve, with progressive reductions in cannulation and fluoroscopy times as the operator volume increased, compared to right radial access [6].…”