title: The left radial approach in daily practice. A randomized study comparing femoral and right and left radial approaches.
abstract: OBJECTIVE
  The right radial (RR) approach has been incorporated into daily clinical practice as a valid alternative to the femoral (F) approach. The left radial (LR) approach is seldom used and few data are available from randomized studies comparing this approach with F and RR approaches.
  
  
  METHODS
  We randomized 1005 consecutive patients referred to a tertiary-care hospital for cardiac catheterization to different approaches. Procedures were performed by three interventional cardiologists experienced in transradial catheterization. There were no exclusion criteria. The primary end-point was the percentage of procedures completed using the assigned approach. Secondary endpoints were the percentage completed in the absence of contraindications to any approach, the duration of the procedure, and the incidence of vascular complications.
  
  
  RESULTS
  More procedures were completed with the F approach (LR, 71%; F, 92%; RR, 68%; P< .001). The success rate in the absence of contraindications to any approach (n=907) was greater with the F approach, with no difference between LR and RR approaches (LR, 80%; F, 96%; RR, 82%; P< .001). The canalization time was greater with the LR approach (P< .001), the time required for diagnosis was shorter with the F approach (P< .001) and compression was faster with the radial approach (P< .001). There was no difference in the total duration of diagnostic procedures (P=.22) or interventions (P=.9). The incidence of vascular complications was lower with the radial approach (P=.03).
  
  
  CONCLUSIONS
  The left radial approach is as valid an alternative to the femoral approach as the right radial approach.
authors.affiliation: Servicio de Cardiología, Hospital Clínico y Universitario de Valencia, Valencia, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Santas
authors.forename: Vicente
authors.initials: V
authors.lastname: Bodí
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchis
authors.forename: Julio
authors.initials: J
authors.lastname: Núñez
authors.forename: Luis
authors.initials: L
authors.lastname: Mainar
authors.forename: Gema
authors.initials: G
authors.lastname: Miñana
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Chorro
authors.forename: Angel
authors.initials: A
authors.lastname: Llácer
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D000075202:Contraindications; D023381:Endpoint Determination; D005260:Female; D005263:Femoral Artery / Q000033:anatomy & histology / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017534:Radial Artery / Q000033:anatomy & histology / Q000502:physiology*