Vía radial derecha o izquierda en la coronariografía. Importancia en la curva de aprendizaje

Portales, Javier Fernández; Valdesuso, Raúl; Carreras, Raúl; Jiménez‐Candil, Javier; Serrador, Ana; Romaní, Sebastián

doi:10.1157/13093986

Cited by 14 publications

(8 citation statements)

References 11 publications

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“…The initial search for the randomized clinical trials that compared the left with the right radial access for the diagnostic or interventional coronary procedures yielded 435 potentially relevant articles. Applying further inclusion/exclusion criteria left a total of 22 articles [1], [2], [4]–[9], [13]–[26] involving 5317 patients assigned to the left radial access and 4970 patients assigned to the right radial access in final analyses. All qualified articles were published between 2001 and 2013, and ten of them were written in Chinese language [5], [18]–[26].…”

Section: Resultsmentioning

confidence: 99%

“…Four of 22 qualified articles recorded outcomes separately by the diagnostic and interventional coronary procedures [4], [7], [18], [24], and one article additionally recorded outcomes from experts [9]. Nine articles involved patients of Caucasian descent [1], [4], [6], [9], [13]–[17], 12 articles of Asian descent [2], [5], [8], [18]–[26], and one article of mixed descents [7]. The average success rate of cardiac catheterization was 96.22% and 95.39% for the left and the right radial accesses, respectively (Table S1).…”

Section: Resultsmentioning

confidence: 99%

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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

Guo

Ding

et al. 2013

PLoS ONE

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

Guo

Ding

et al. 2013

PLoS ONE

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“…The LRA offers the theoretical advantage of avoiding this passage and permitting a more direct access to ascending aorta. These differences have been reflected in clinical terms in certain studies such as those of Kawashima et al [14], in which the LRA shortened the procedure and examination time, and of Fernandez‐Portales et al [15] in which the RRA was associated with a higher failure rate due to the problems with the tortuosity and atherosclerosis of the right brachiocephalic trunk. In addition, the study from Santas et al [16] has shown that the LRA may provide at least similar procedural efficacy compared with the RRA.…”

Section: Discussionmentioning

confidence: 99%

A randomized study comparing the effectiveness of right and left radial approach for coronary angiography

Norgaz

Görgülü

Dağdelen

2012

Cathet Cardio Intervent

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“…Three of the 14 RCTs were from North America ( 27 , 28 , 30 ), 7 were from Europe ( 13 , 16 , 17 , 24 , 25 , 31 , 33 ), and 4 were from Asia ( 15 , 26 , 29 , 32 ). Table 1 lists the characteristics of the included trials.…”

Section: Resultsmentioning

confidence: 99%

“…Recent investigations found that the LRA was associated with lower fluoroscopy time (FT) and operator radiation exposure ( 13 , 14 ). Increased interest in the LRA, which offers all the advantages of the RRA and avoids most of its disadvantages, has led to reports proposing that the LRA offers greater benefits than the RRA ( 15 , 16 ). However, the evidence supporting these proposals is not robust, and recent randomized controlled trials (RCTs) have yielded conflicting results ( 13 ,).…”

Section: Introductionmentioning

confidence: 99%

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

Sheng

Zhang

Zhou

et al. 2015

Braz J Med Biol Res

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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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Vía radial derecha o izquierda en la coronariografía. Importancia en la curva de aprendizaje

Cited by 14 publications

References 11 publications

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

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

A randomized study comparing the effectiveness of right and left radial approach for coronary angiography

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

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