Effect of Vascular Access Site Choice on Radiation Exposure During Coronary Angiography

Pancholy, Samir; Joshi, Pankaj; Shah, Sanjay; Rao, Sunil V.; Bertrand, Olivier; Patel, Tejas

doi:10.1016/j.jcin.2015.03.026

Cited by 59 publications

(11 citation statements)

References 18 publications

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“…Moreover, Gray et al (12) have found similar radiation exposure for both femoral and radial approaches in patients who underwent diagnostic CA. Furthermore, the REVERE trial noted that radiation exposure to patients was similar during diagnostic CA, irrespective of the vascular access site (13). However, Mercuri et al (14) have stated that radial approach was a predictor of increased radiation exposure during diagnostic CA.…”

Section: Discussionmentioning

confidence: 99%

IS Trans-Radial Approach Related to an Increased RisK of RAdiation Exposure In Patients Who Underwent Diagnostic CoronaRY Angiography or Percutaneous Coronary Intervention? (The SAKARYA Study)

et al. 2019

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Objective: It is still debatable whether diagnostic coronary angiography (CA) or percutaneous coronary interventions (PCIs) increase radiation exposure when performed via radial approach as compared to femoral approach. This question was investigated in this study by comparison of dose-area product (DAP), reference air kerma (RAK), and fluoroscopy time (FT) among radial and femoral approaches. Methods: All coronary procedures between November 2015 and November 2017 were assessed; and 4215 coronary procedures were enrolled in the study. Patients with bifurcation, chronic total occlusion, cardiogenic shock, or prior coronary artery bypass surgery were excluded. These 4215 procedures were evaluated for three different categories: diagnostic CA (Group I), PCI in patients with stable angina (Group II), and PCI in patients with ACS (Group III). Results: Age was significantly higher in the femoral arm of all groups. Among patients in the radial arm of Groups I and II, males were over-represented. Therefore, a multiple linear regression analysis with stepwise method was performed. After adjusting these clinical confounders, there was no significant difference with regard to DAP, RAK, and FT between femoral and radial access in Group I. In contrast, PCI via radial access was significantly associated with increased DAP, RAK, and FT in Groups II and III. Conclusion: In spite of an increased experience with trans-radial approach, PCI of coronary lesions via radial route was associated with a relatively small but significant radiation exposure in our study. Compared to femoral access, diagnostic CA via radial access was not related to an increased radiation exposure.

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Section: Discussionmentioning

confidence: 99%

IS Trans-Radial Approach Related to an Increased RisK of RAdiation Exposure In Patients Who Underwent Diagnostic CoronaRY Angiography or Percutaneous Coronary Intervention? (The SAKARYA Study)

et al. 2019

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“…In the 1467 patients undergoing diagnostic coronary angiography, LRA resulted in lower DAP and fluoroscopy time than RRA. The Randomized Evaluation of Vascular Entry Site and Radiation Exposure (REVERE) trial, on the other hand, randomized 1493 patients undergoing coronary angiography at a tertiary care center in India 1:1:1 to LRA, RRA, or TFA and demonstrated no significant differences in radiation exposure between the three groups in this “all-comers” population [11]. …”

Section: Discussionmentioning

confidence: 99%

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

Shah

Burdowski

Guo

et al. 2016

The American Journal of Cardiology

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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.

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“…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].…”

Section: Areas Of Researchmentioning

confidence: 99%

Radial Artery Access

Panetta¹,

Chahine²

2021

Interventional Treatment for Structural Heart Disease

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Radial artery access for angiography has matured over the past two decades and is now the preferred point of access for most patients. Lower bleeding rates in clinical randomized trials have translated into lower mortality prompting change in the guidelines. Advances in technique with use of ultrasound for access to properly size the sheath, proper dosing of anticoagulation and new techniques for sheath removal have dramatically lowered radial artery occlusion rates. Radial artery spasm has improved with vasodilators and proper sedation. Advances in support boards and sheath extension have opened up left radial access. Advances in lower profile sheaths and sheathless systems allow larger catheters in smaller arteries. Advances in longer balloons and sheaths have opened up radial access for peripheral interventions. Areas of clinical research include use of ulnar artery compared to radial, left versus right radial access, use of radial artery for a surgical conduit after angiography, radiation exposure and advantage of radial approach in the elderly.

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Effect of Vascular Access Site Choice on Radiation Exposure During Coronary Angiography

Cited by 59 publications

References 18 publications

IS Trans-Radial Approach Related to an Increased RisK of RAdiation Exposure In Patients Who Underwent Diagnostic CoronaRY Angiography or Percutaneous Coronary Intervention? (The SAKARYA Study)

IS Trans-Radial Approach Related to an Increased RisK of RAdiation Exposure In Patients Who Underwent Diagnostic CoronaRY Angiography or Percutaneous Coronary Intervention? (The SAKARYA Study)

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

Radial Artery Access

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