title: Right versus left radial artery access for coronary procedures: an international collaborative systematic review and meta-analysis including 5 randomized trials and 3210 patients.
abstract: BACKGROUND
  Radial 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.
  
  
  METHODS
  Pertinent 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).
  
  
  RESULTS
  A 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.
  
  
  CONCLUSIONS
  Right 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.
authors.affiliation: Division of Cardiology, University of Modena and Reggio Emilia, Modena, Italy. gbiondizoccai@gmail.com
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sciahbasi
authors.forename: Vicente
authors.initials: V
authors.lastname: Bodí
authors.forename: Javier
authors.initials: J
authors.lastname: Fernández-Portales
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Kanei
authors.forename: Enrico
authors.initials: E
authors.lastname: Romagnoli
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Agostoni
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sangiorgi
authors.forename: Marzia
authors.initials: M
authors.lastname: Lotrionte
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Modena
mesh_terms: D003299:Cooperative Behavior; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D038622:Internationality; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D017534:Radial Artery / Q000473:pathology* / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic / Q000379:methods