Abstract
BackgroundRadial artery access is a mainstay in the diagnosis and treatment of coronary artery disease. However, there is uncertainty on the comparison of right versus left radial access for coronary procedures. We thus undertook a systematic review and meta-analysis comparing right versus left radial access for coronary diagnostic and interventional procedures. MethodsPertinent studies were searched in CENTRAL, Google Scholar, MEDLINE/PubMed, and Scopus, together with international conference proceedings. Randomized trials comparing right versus left radial (or ulnar) access for coronary diagnostic or interventional procedures were included. Risk ratios (RR) and weighted mean differences (WMD) were computed to generate point estimates (95% confidence intervals). ResultsA total of 5 trials (3210 patients) were included. No overall significant differences were found comparing right versus left radial access in terms of procedural time (WMD=0.99 [−0.53; 2.51]min, p=0.20), contrast use (WMD=1.71 [−1.32; 4.74]mL, p=0.27), fluoroscopy time (WMD=−35.79 [−3.54; 75.12]s, p=0.07) or any major complication (RR=2.00 [0.75; 5.31], p=0.49). However, right radial access was fraught with a significantly higher risk of failure leading to cross-over to femoral access (RR=1.65 [1.18; 2.30], p=0.003) in comparison to left radial access. ConclusionsRight and left radial accesses appear largely similar in their overall procedural and clinical performance during transradial diagnostic or interventional procedures. Nonetheless, left radial access can be recommended especially during the learning curve phase to reduce femoral cross-overs.
Highlights
Since the first pioneering experiences [1,2], radial artery access has gained ongoing momentum as a safe and effective approach for diagnostic and interventional procedures in patients with or at risk for coronary artery disease [3]
Limited evidence and conflicting trials have been reported on the comparison of right versus left radial access in patients undergoingcoronary procedures [9,10]
CENTRAL, Google Scholar, MEDLINE/PubMed and Scopus were searched by two independent reviewers (GBZ, ML) for studies comparing right versus left radial access for diagnostic or interventional coronary procedures published up to 15 April, 2011
Summary
Since the first pioneering experiences [1,2], radial artery access has gained ongoing momentum as a safe and effective approach for diagnostic and interventional procedures in patients with or at risk for coronary artery disease [3]. We undertook a systematic review and meta-analysis comparing right versus left radial access for coronary diagnostic and interventional procedures. Randomized trials comparing right versus left radial (or ulnar) access for coronary diagnostic or interventional procedures were included. No overall significant differences were found comparing right versus left radial access in terms of procedural time (WMD = 0.99 [− 0.53; 2.51] min, p = 0.20), contrast use (WMD = 1.71 [− 1.32; 4.74] mL, p = 0.27), fluoroscopy time (WMD = − 35.79 [− 3.54; 75.12] s, p = 0.07) or any major complication (RR = 2.00 [0.75; 5.31], p = 0.49). Left radial access can be recommended especially during the learning curve phase to reduce femoral cross-overs
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