Right and left radial access for coronary angiography and percutaneous coronary intervention after coronary artery bypass graft surgery: no need to go down

Abstract

Abstract Introduction Currently is estimated that at least 90% of the coronary studies are performed through the radial access. However, in patients with prior coronary artery bypass graft surgery (CABG) the femoral access continues to be widely used due to an easier and more successful graft engagement. Evidence of the efficacy and security of the radial approach use in this population is both scarce and controversial. Purpose We aimed to compare radial (right and left) versus femoral access to perform coronary angiography (CA) and/or percutaneous coronary intervention (PCI) after CABG. Methods In this comparative historical cohort study conducted at a national reference center, all CA and PCI performed from January 2012 to October 2022 were eligible for review. Electronic and physical records were examined for demographic and interventional data. Groups were classified for comparison as CA plus PCI, CA only and PCI only. Results We identified 563 patients; radial access was used in 227 (40%). In CA plus PCI group, in only one case existed failure to cannulate bypass grafts by the initial chosen access (from right radial access [RRA] to the left internal mammary artery [LIMA]). The crossover rate for any cause other than graft cannulation failure was 11.3% with right radial access (p = 0.002), 4.2% with left radial access (p = 0.28) and 0% with the femoral route. Fluoroscopy time was greater in RRA compared to femoral, nevertheless left radial access (LRA) had lower fluoroscopy time and contrast volume compared to RRA and femoral access. In the CA only group, failure to cannulate bypass grafts occurred exclusively when the LIMA had to be cannulated from the RRA (8.3% p=0.001); with a crossover rate for any cause other than graft cannulation failure was greater in the radial access compared to femoral (RRA 18.1% p < 0.001; LRA 4.2% p = 0.002; femoral 0.5% P=0.001), LRA had greater fluoroscopy time but the femoral access had greater contrast volume use in relation with a higher number of venous bypass grafts [143.64 mL (±69.36), p = 0.01]. There were 15 cases of PCI only, were fluoroscopy time and contrast volume were greater in LRA (N= 2 none were for treatment of LIMA) and lower in RRA compared to LRA and femoral access. Vascular complications were infrequent in all groups, being minor bleeding in the femoral access the most frequent, with no statistical significance. Conclusion Right and left radial access are feasible to perform coronary angiography and PCI after CABG, compared to the femoral route are associated with less contrast volume despite a greater crossover rate. This analysis suggests that the LRA should be preferred over the RRA when angiography of the LIMA is needed.