Abstract 17350: Comparison of Radiological Risk Between Transfemoral and Transradial Approach: An Updated Meta-Analysis

Abstract

Background: Studies have shown that transradial approach (TR) is associated with increased radiation exposure compared to transfemoral (TF) approach. However, it is believed that the difference in radiation exposure may not be significant between the two approaches when performed by experienced operators, as TR approach has a challenging learning curve. Newer studies have shown conflicting results in radiation exposure between the two treatment strategies. Hence, we sought to perform a meta-analysis comparing the radiation exposure between TR and TF approach during coronary angiography (CA) and percutaneous coronary intervention (PCI). Methods: We searched PubMed, EMBASE and SCOPUS for eligible studies. 27 randomized controlled trials (RCTs) were included in our analysis. Outcomes analyzed were Fluoroscopy time (FT) in minutes and dose-area product (DAP) in Gy/cm2. We used Inverse variance random effects model to calculate the mean difference (MD) and 95% confidence interval (CI). We performed a subgroup analysis of trials that compared the two approaches for CA and PCI separately. We also performed a subgroup analysis of trials that only included self-identified experienced operators. Results: FT was reported by 26 trials and was significantly higher with TR approach for both CA (MD=1.28, 95% CI 0.78 to 1.77, P <0.00001) and PCI (MD=0.96, 95% CI 0.59 to 1.33, P<0.00001). FT was still higher (MD=0.95, 95% CI 0.63 to 1.27, P<0.00001) in subgroup analysis of trials that only included experienced operators. DAP was only reported in 10 trials and there was no significant difference between TR and TF approach for both CA (MD=1.44, 95% CI -0.52 to 3.41, P=0.15) and PCI (MD=0.54, 95% CI -4.45 to 5.53, P=0.83). There was also no significant difference in DAP (MD=0.81, 95% CI -3.68 to 5.29, P=0.79) between the two approaches in trials that only included experienced operators. Conclusions: TR approach is associated with higher radiation exposure than TF approach even with experienced operators. However, the clinical significance of this finding has to be evaluated in larger RCTs.