Effect of Left Versus Right Radial Artery Approach for Coronary Angiography on Radiation Parameters in Patients With Predictors of Transradial Access Failure

Abstract

Left transradial approach (TRA) for coronary angiography is associated with lower radiation parameters than right TRA in an all-comers population. The aim of this study was to determine the effects of left versus right TRA on radiation parameters in patients with predictors of TRA failure. Patients with predictors of TRA failure (≥3 of 4 following criteria: age ≥70 years, female sex, height ≤64 inches, hypertension) referred to TRA operators were randomized to either right (n=50) or left (n=50) TRA, while those referred to transfemoral approach (TFA) operators were enrolled in a prospective registry (n=50). The primary endpoint was the radiation measure of dose area product (DAP). In an intention-to-treat analysis, DAP (34.1 Gy*cm2 [24.9–45.6] vs 41.9 Gy*cm2 [27.3–58.0], p=0.08), fluoroscopy time (3.7 min [2.4–6.3] vs 5.6 min [3.1–8.7], p=0.07), and operator radiation exposure (516 uR [275–967] vs. 730 uR [503–1165], p=0.06) were not significantly different between left and right TRA, but total dose (411 mGy [310–592] vs 537 mGy [368–780], p=0.03) was significantly lower with left versus right TRA. Radiation parameters were lowest in the TFA cohort (DAP 24.5 Gy*cm2 [15.7–33.2], p<0.001; fluoroscopy time 2.3 min [1.5–3.7], p<0.001; operator radiation exposure 387 uR [264–557]; total dose 345 mGy [250–468], p=0.001). Results were similar after adjustment for differences in baseline characteristics. In conclusion, median measures of radiation were overall not significantly different between left versus right TRA in this select population of patients with predictors of TRA failure. All measures of radiation were lowest in the TFA group.

Size Matters: Moving Toward a Slender Transradial Artery Approach

“…Our group performed a single-center randomized trial to evaluate the effect of arterial access site (left vs. right TRA) on radiation parameters in patients with predictors of TRA failure (≥3 of 4 following criteria: age ≥70 years, female sex, height ≤64 inches, hypertension). In this study, more than 90% of patients enrolled were women with short stature, and parameters of radiation were numerically but not statistically lower with the use of left TRA [12]. No conclusive data, though, are available on the optimal Fr size in these patients at high risk of failure to complete procedures via TRA.…”

Aberrant Right Subclavian Artery with a Bicarotid Trunk: The Importance of Diagnosing This Rare Incidental Anomaly

“…It significantly lowers the risk of access site complications compared to the transfemoral approach and is, therefore, becoming a preferred access site [9]. The right TRA is more commonly used in the majority of interventions [11]. The TRA coronary procedures with the presence of ARSA may result in unforeseen problems; one of them is an injury of the vessel.…”

Radial Artery Access

“…Stand Tall, Radux Devices) and left arm support systems. Multiple randomized trials found less radiation with left versus right radial [45][46][47][48][49] although one trial found more radiation with left radial [50]. Avoiding steep angles, particularly LAO -Caudal, lower magnification, lower frame rate with fluoroscopy, and distance is recommended [51,52].…”