A prospective randomized comparison of left and right radial approach for percutaneous coronary angiography in Asian populations

Hongyu Hu, Qiang Fu, Wei Chen, Dezhao Wang, Xu Hua, Buxing Chen, Hongyu Hu, Qiang Fu, Wei Chen, Dezhao Wang, Xu Hua, Buxing Chen

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.

Keywords: coronary angiography; left radial approach; right radial approach.

Figures

Figure 1
Figure 1
Flow diagram of the study. Notes: Comparison between the left and right radial approaches for coronary angiography. In 1,362 of the 1,400 randomized patients, a coronary angiography was performed successfully. Abbreviation: n, number.

References

    1. Archbold RA, Robinson NM, Schilling RJ. Radial artery access for coronary angiography and percutaneous coronary intervention. BMJ. 2004;329(7463):443–446.
    1. Agostoni P, Biondi-Zoccai GG, de Benedictis ML, et al. Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures; Systematic overview and meta-analysis of randomized trials. J Am Coll Cardiol. 2004;44(2):349–356.
    1. Brasselet C, Tassan S, Nazeyrollas P, Hamon M, Metz D. Randomised comparison of femoral versus radial approach for percutaneous coronary intervention using abciximab in acute myocardial infarction: results of the FARMI trial. Heart. 2007;93(12):1556–1561.
    1. Pristipino C, Pelliccia F, Granatelli A, et al. 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):1216–1221.
    1. Rao SV, Ou FS, Wang TY, et al. 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. 2008;1(4):379–386.
    1. Jolly SS, Amlani S, Hamon M, Yusuf S, Mehta SR. 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. 2009;157(1):132–140.
    1. Jolly SS, Yusuf S, Cairns J, et al. RIVAL trial group 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):1409–1420.
    1. Valgimigli M, Saia F, Guastaroba P, et al. REAL Registry Investigators 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.
    1. Lo TS, Nolan J, Fountzopoulos E, et al. Radial artery anomaly and its influence on transradial coronary procedural outcome. Heart. 2009;95(5):410–415.
    1. Dominici M, Diletti R, Milici C, et al. Left radial versus right radial approach for coronary artery catheterization: a prospective comparison. J Interv Cardiol. 2012;25(2):203–209.
    1. Sciahbasi A, Romagnoli E, Burzotta F, et al. Transradial approach (left vs right) and procedural times during percutaneous coronary procedures: TALENT study. Am Heart J. 2011;161(1):172–179.
    1. Pelliccia F, Trani C, Biondi-Zoccai GG, et al. Prospective Registry of Vascular Access in Interventions in Lazio Region (PREVAIL) Study Group 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):771–775.
    1. Kawashima O, Endoh N, Terashima M, et al. Effectiveness of right or left radial approach for coronary angiography. Catheter Cardiovasc Interv. 2004;61(3):333–337.
    1. Fernández-Portales J, Valdesuso R, Carreras R, Jiménez-Candil J, Serrador A, Romaní S. Right versus left radial artery approach for coronary angiography. Differences observed and the learning curve. Rev Esp Cardiol. 2006;59(10):1071–1074. Spanish.
    1. Santas E, Bodí V, Sanchis J, et al. The left radial approach in daily practice. A randomized study comparing femoral and right and left radial approaches. Rev Esp Cardiol. 2009;62(5):482–490.
    1. Kanei Y, Nakra NC, Liou M, et al. Randomized comparison of transradial coronary angiography via right or left radial artery approaches. Am J Cardiol. 2011;107(2):195–197.
    1. Biondi-Zoccai G, Sciahbasi A, Bodí V, et al. 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. 2013;166(3):621–626.
    1. Sciahbasi A, Romagnoli E, Trani C, et al. Evaluation of the “learning curve” for left and right radial approach during percutaneous coronary procedures. Am J Cardiol. 2011;108(2):185–188.
    1. Bhat T, Teli S, Bhat H, et al. Access-site complications and their management during transradial cardiac catheterization. Expert Rev Cardiovasc Ther. 2012;10(5):627–634.
    1. Dahm JB, van Buuren F. Transradial percutaneous coronary interventions: indications, success rates and clinical outcome. Indian Heart J. 2010;62(3):218–220.
    1. Kiemeneij F. Prevention and management of radial artery spasm. J Invasive Cardiol. 2006;18(4):159–160.
    1. Ruiz-Salmerón RJ, 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):192–198.
    1. Kim SH, Kim EJ, Cheon WS, et al. Comparative study of nicorandil and a spasmolytic cocktail in preventing radial artery spasm during transradial coronary angiography. Int J Cardiol. 2007;120(3):325–330.
    1. Segal AZ, Abernethy WB, Palacios IF, BeLue R, Rordorf G. Stroke as a complication of cardiac catheterization: risk factors and clinical features. Neurology. 2001;56(7):975–977.
    1. Fuchs S, Stabile E, Kinnaird TD, et al. Stroke complicating percutaneous coronary interventions: incidence, predictors, and prognostic implications. Circulation. 2002;106(1):86–91.
    1. Karalis DG, Quinn V, Victor MF, et al. Risk of catheter-related emboli in patients with atherosclerotic debris in the thoracic aorta. Am Heart J. 1996;131(6):1149–1155.
    1. Büsing KA, Schulte-Sasse C, Flüchter S, et al. Cerebral infarction: incidence and risk factors after diagnostic and interventional cardiac catheterization – prospective evaluation at diffusion-weighted MR imaging. Radiology. 2005;235(1):177–183.
    1. Lund C, Nes RB, Ugelstad TP, et al. Cerebral emboli during left heart catheterization may cause acute brain injury. Eur Heart J. 2005;26(13):1269–1275.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir