Comparative efficacy and safety of the left versus right radial approach for percutaneous coronary procedures: a meta-analysis including 6870 patients

• Published in: Brazilian journal of medical and biological research Vol. 48; no. 8; pp. 743 - 750
• Main Authors: Xia, S L, Zhang, X B, Zhou, J S, Gao, X
• Format: Journal Article
• Language: English
• Published: Brazil Associacao Brasileira de Divulgacao Cientifica (ABDC) 01.08.2015; Associação Brasileira de Divulgação Científica
• Subjects: Analysis; BIOLOGY; Care and treatment; Clinical Investigation; Coronary angiography; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - surgery; Coronary heart disease; Fluoroscopy - methods; Humans; MEDICINE, RESEARCH & EXPERIMENTAL; Meta-analysis; Percutaneous coronary; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - methods; Radial approach; Radial Artery - diagnostic imaging; Radial Artery - surgery; Randomized Controlled Trials as Topic; Safety and security measures; Subclavian Artery - anatomy & histology; Time Factors; Percutaneous coronary; Radial approach; Meta-analysis
• ISSN: 0100-879X; 1414-431X; 1414-431X
• DOI: 10.1590/1414-431X20154571

The radial approach is widely used in the treatment of patients with coronary artery disease. We conducted a meta-analysis of published results on the efficacy and safety of the left and right radial approaches in patients undergoing percutaneous coronary procedures. A systematic search of reference databases was conducted, and data from 14 randomized controlled trials involving 6870 participants were analyzed. The left radial approach was associated with significant reductions in fluoroscopy time [standardized mean difference (SMD)=-0.14, 95% confidence interval (CI)=-0.19 to -0.09; P<0.00001] and contrast volume (SMD=-0.07, 95%CI=-0.12 to -0.02; P=0.009). There were no significant differences in rate of procedural failure of the left and the right radial approaches [risk ratios (RR)=0.98; 95%CI=0.77-1.25; P=0.88] or procedural time (SMD=-0.05, 95%CI=0.17-0.06; P=0.38). Tortuosity of the subclavian artery (RR=0.27, 95%CI=0.14-0.50; P<0.0001) was reported more frequently with the right radial approach. A greater number of catheters were used with the left than with the right radial approach (SMD=0.25, 95%CI=0.04-0.46; P=0.02). We conclude that the left radial approach is as safe as the right radial approach, and that the left radial approach should be recommended for use in percutaneous coronary procedures, especially in percutaneous coronary angiograms.