A Prospective Randomized Comparison of Left and Right Radial Approach for Percutaneous Coronary Angiography in Asian Populations

Overview

Journal Clin Interv Aging

Publisher Dove Medical Press

Specialty Geriatrics

Date 2014 Jul 15

PMID 25018624

Citations 5

Authors

Hongyu Hu

Qiang Fu

Wei Chen

Dezhao Wang

Xu Hua

Buxing Chen

Affiliations

Soon will be listed here.

Abstract

Background: The efficacy of coronary angiography may be different in the right radial approach (RRA) and the left radial approach (LRA) due to more common vascular tortuosity in the RRA. The aim of the study was to determine whether LRA is a valid alternative for coronary angiography compared with RRA in Asian populations.

Methods: This is a single-center, prospective, randomized controlled study. A total of 1,400 consecutive patients undergoing diagnostic coronary angiography were recruited and randomized to the RRA (number [n]=700) or LRA (n=700) group. The primary end point was total procedural duration. Secondary end points included fluoroscopy time, dose of radiation including cumulative air kerma and dose area product, contrast volume, and the incidence of vascular complications.

Results: Coronary procedural success was achieved in 682 of 700 (97.4%) patients in the RRA and 680 of 700 (97.1%) in the LRA. The total procedural time (RRA 14.1±6.3 minutes versus LRA 13.2±6.0 minutes; P=0.006) and fluoroscopy time (RRA 3.8±3.3 minutes versus LRA 3.4±2.8 minutes; P=0.046) were significantly shorter via LRA in comparison to RRA. The percentage of hydrophilic wire use was also lower in the LRA group (14% [RRA] versus 10% [LRA]; P=0.016). The dose of radiation and contrast volume were not different between the two approaches. No cases of major bleeding and vascular complications requiring surgical intervention were reported, other than with one patient who experienced a symptomatic stroke and died in the RRA group compared with none in the LRA group.

Conclusion: The LRA seems to be a feasible alternative for coronary angiography in Asian patients due to shorter procedural duration and fluoroscopy time, as well as less hydrophilic wire use in comparison to RRA.

Citing Articles

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

Balaban Y, Akbas M, Akbas M, Ozerdem A Braz J Cardiovasc Surg. 2019; 34(1):48-56.

PMID: 30810674 PMC: 6385842. DOI: 10.21470/1678-9741-2018-0270.

Radial Artery and Ulnar Artery Occlusions Following Coronary Procedures and the Impact of Anticoagulation: (Radial and Ulnar ry Occlusion eta-Analys) Systematic Review and Meta-Analysis.

Hahalis G, Aznaouridis K, Tsigkas G, Davlouros P, Xanthopoulou I, Koutsogiannis N J Am Heart Assoc. 2017; 6(8).

PMID: 28838915 PMC: 5586412. DOI: 10.1161/JAHA.116.005430.

Radiation Exposures Associated With Radial and Femoral Coronary Interventions.

Voudris K, Habibi M, Karyofillis P, Vidovich M Curr Treat Options Cardiovasc Med. 2016; 18(12):73.

PMID: 27778258 DOI: 10.1007/s11936-016-0499-x.

Randomized comparative study of left versus right radial approach in the setting of primary percutaneous coronary intervention for ST-elevation myocardial infarction.

Fu Q, Hu H, Wang D, Chen W, Tan Z, Li Q Clin Interv Aging. 2015; 10:1003-8.

PMID: 26150704 PMC: 4484656. DOI: 10.2147/CIA.S81568.

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

Xia S, Zhang X, Zhou J, Gao X Braz J Med Biol Res. 2015; 48(8):743-50.

PMID: 26108097 PMC: 4541695. DOI: 10.1590/1414-431X20154571.

References

Lund C, Nes R, Ugelstad T, Due-Tonnessen P, Andersen R, Kristian Hol P . Cerebral emboli during left heart catheterization may cause acute brain injury. Eur Heart J. 2005; 26(13):1269-75. DOI: 10.1093/eurheartj/ehi148. View

Ruiz-Salmeron R, Mora R, Masotti M, Betriu A . Assessment of the efficacy of phentolamine to prevent radial artery spasm during cardiac catheterization procedures: a randomized study comparing phentolamine vs. verapamil. Catheter Cardiovasc Interv. 2005; 66(2):192-8. DOI: 10.1002/ccd.20434. View

Jolly S, Yusuf S, Cairns J, Niemela K, Xavier D, Widimsky P . Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet. 2011; 377(9775):1409-20. DOI: 10.1016/S0140-6736(11)60404-2. View

Fernandez-Portales J, Valdesuso R, Carreras R, Jimenez-Candil J, Serrador A, Romani S . [Right versus left radial artery approach for coronary angiography. Differences observed and the learning curve]. Rev Esp Cardiol. 2006; 59(10):1071-4. DOI: 10.1157/13093986. View

Pelliccia F, Trani C, Biondi-Zoccai G, Nazzaro M, Berni A, Patti G . Comparison of the feasibility and effectiveness of transradial coronary angiography via right versus left radial artery approaches (from the PREVAIL Study). Am J Cardiol. 2012; 110(6):771-5. DOI: 10.1016/j.amjcard.2012.05.005. View

Jolly S, Amlani S, Hamon M, Yusuf S, Mehta S . Radial versus femoral access for coronary angiography or intervention and the impact on major bleeding and ischemic events: a systematic review and meta-analysis of randomized trials. Am Heart J. 2008; 157(1):132-40. DOI: 10.1016/j.ahj.2008.08.023. View

Kanei Y, Nakra N, Liou M, Vales L, Gowda R, Rosero H . Randomized comparison of transradial coronary angiography via right or left radial artery approaches. Am J Cardiol. 2010; 107(2):195-7. DOI: 10.1016/j.amjcard.2010.08.065. View

Kim S, Kim E, Cheon W, Kim M, Park W, Cho G . Comparative study of nicorandil and a spasmolytic cocktail in preventing radial artery spasm during transradial coronary angiography. Int J Cardiol. 2007; 120(3):325-30. DOI: 10.1016/j.ijcard.2006.10.008. View

Valgimigli M, Saia F, Guastaroba P, Menozzi A, Magnavacchi P, Santarelli A . Transradial versus transfemoral intervention for acute myocardial infarction: a propensity score-adjusted and -matched analysis from the REAL (REgistro regionale AngiopLastiche dell'Emilia-Romagna) multicenter registry. JACC Cardiovasc Interv. 2012; 5(1):23-35. DOI: 10.1016/j.jcin.2011.08.018. View

10.

Sciahbasi A, Romagnoli E, Burzotta F, Trani C, Sarandrea A, Summaria F . Transradial approach (left vs right) and procedural times during percutaneous coronary procedures: TALENT study. Am Heart J. 2010; 161(1):172-9. DOI: 10.1016/j.ahj.2010.10.003. View

11.

Archbold R, Robinson N, Schilling R . Radial artery access for coronary angiography and percutaneous coronary intervention. BMJ. 2004; 329(7463):443-6. PMC: 514212. DOI: 10.1136/bmj.329.7463.443. View

12.

Karalis D, Quinn V, Victor M, Ross J, Polansky M, Spratt K . Risk of catheter-related emboli in patients with atherosclerotic debris in the thoracic aorta. Am Heart J. 1996; 131(6):1149-55. DOI: 10.1016/s0002-8703(96)90090-3. View

13.

Dahm J, van Buuren F . Transradial percutaneous coronary interventions: indications, success rates & clinical outcome. Indian Heart J. 2011; 62(3):218-20. View

14.

Pristipino C, Pelliccia F, Granatelli A, Pasceri V, Roncella A, Speciale G . Comparison of access-related bleeding complications in women versus men undergoing percutaneous coronary catheterization using the radial versus femoral artery. Am J Cardiol. 2007; 99(9):1216-21. DOI: 10.1016/j.amjcard.2006.12.038. View

15.

Rao S, Ou F, Wang T, Roe M, Brindis R, Rumsfeld J . Trends in the prevalence and outcomes of radial and femoral approaches to percutaneous coronary intervention: a report from the National Cardiovascular Data Registry. JACC Cardiovasc Interv. 2009; 1(4):379-86. DOI: 10.1016/j.jcin.2008.05.007. View

16.

Fuchs S, Stabile E, Kinnaird T, Mintz G, Gruberg L, Canos D . Stroke complicating percutaneous coronary interventions: incidence, predictors, and prognostic implications. Circulation. 2002; 106(1):86-91. DOI: 10.1161/01.cir.0000020678.16325.e0. View

17.

Dominici M, Diletti R, Milici C, Bock C, Garg S, De Paolis M . Left radial versus right radial approach for coronary artery catheterization: a prospective comparison. J Interv Cardiol. 2012; 25(2):203-9. DOI: 10.1111/j.1540-8183.2011.00689.x. View

18.

Biondi-Zoccai G, Sciahbasi A, Bodi V, Fernandez-Portales J, Kanei Y, Romagnoli E . Right versus left radial artery access for coronary procedures: an international collaborative systematic review and meta-analysis including 5 randomized trials and 3210 patients. Int J Cardiol. 2011; 166(3):621-6. DOI: 10.1016/j.ijcard.2011.11.100. View

19.

Busing K, Schulte-Sasse C, Fluchter S, Suselbeck T, Haase K, Neff W . Cerebral infarction: incidence and risk factors after diagnostic and interventional cardiac catheterization--prospective evaluation at diffusion-weighted MR imaging. Radiology. 2005; 235(1):177-83. DOI: 10.1148/radiol.2351040117. View

20.

Segal A, Abernethy W, Palacios I, BeLue R, Rordorf G . Stroke as a complication of cardiac catheterization: risk factors and clinical features. Neurology. 2001; 56(7):975-7. DOI: 10.1212/wnl.56.7.975. View