Comparison of transradial coronary procedures via right radial versus left radial artery approach: A meta‐analysis

Abstract

Our meta-analysis suggests a small but statistically significant difference in terms of contrast use and fluoroscopy time in favor of coronary procedures performed via left radial approach in comparison to right radial approach without any significant difference in access site or other procedural complications between the two radial approaches. © 2016 Wiley Periodicals, Inc.

Distal transradial artery access in the anatomical snuffbox for coronary angiography as an alternative access site for faster hemostasis

“…This is no surprise as the path needed to perform coronary angiogram from the distal TRA is nearly identical to conventional TRA. Prior meta‐analysis comparing right and left radial approaches showed no significant differences in total procedure time and crossover rate with small benefit in left radial approach in terms of fluoroscopy time and contrast use . Whether the access site is distal or conventional TRA or right or left TRA, the procedural difficulties may originate from the anatomical variation rather than due to the choice of access site.…”

SCAI expert consensus statement update on best practices for transradial angiography and intervention

“…Crossover rates from TRA are estimated at 4–10% due to inability to establish radial access, and failed radial access (due to anatomical issues or operator experience) is associated with worse overall outcomes . Of note, the use of ultrasound is associated with lower TRA crossover rates, and left TRA can be considered as this may further reduce D2B times, especially in difficult patient subsets . When conversion is necessary, either contralateral TRA or femoral arterial access are acceptable .…”

Initial experience with left distal transradial access for invasive coronary procedures

“…1 Embora a técnica radial direita ofereça maior conforto ao operador, variações anatômicas e tortuosidades da artéria subclávia direita são mais frequentes, culminando com maior uso de contraste e tempo de fluoroscopia, quando comparada à téc-nica radial esquerda. 2 Além disto, condições como revascularização miocárdica cirúrgica utilizando enxerto de mamá-ria interna esquerda, obesidade mórbida, idade avançada, baixa estatura, preferência do paciente ou falha prévia na obtenção do acesso radial direito implicam na necessidade de emprego da radial esquerda, reservando-se a via femoral para casos selecionados. 3 Recentemente, a punção distal da artéria radial esquerda 4 através da tabaqueira anatômica, que consiste em uma cavidade triangular na região dorsal da mão, delimitada pelo tendão extensor longo do polegar medialmente, e pelos tendões extensor curto e abdutor longo do polegar lateralmente, com assoalho formado pelos ossos escafoide e trapézio, 5 apresenta-se como um refinamento da técnica descrita há 25 anos.…”