title: Right versus left transradial approach for coronary catheterization in octogenarian patients.
abstract: OBJECTIVE
  The aim of the study was to evaluate if the left radial approach (LRA) confers any additional advantage compared to the right radial approach (RRA) in octogenarian patients who undergo a coronary diagnostic procedure.
  
  
  BACKGROUND
  Octogenarians, an increasing segment of patients in our society, present a higher risk of access-site complications related to invasive coronary catheterization. Transradial approach has been shown to be an effective alternative to reduce vascular complications. Although some studies have suggested that elderly people might benefit from a LRA, the advantages of using the left or right radial access remain not clear.
  
  
  METHODS
  One hundred octogenarian patients undergoing a transradial coronary angiogram with normal Allen test and without previous history of coronary artery by-pass grafting were randomized to either LRA (n = 50) or RRA (n = 50). The primary end-points of the study were procedural and fluoroscopy times.
  
  
  RESULTS
  Mean age was 82.6 years (80-88) and 59% were males. Procedural and fluoroscopy times were similar among study groups. Crossover was required in two patients (4%) with RRA and five patients (10%) with LRA (P = 0.24). Subclavian tortuosity was more frequent in the right side (32% vs. 6% in the left side; P = 0.002) but this difference did not translate into longer procedural or fluoroscopy times or higher cross-over, procedural difficulty or wire manipulation.
  
  
  CONCLUSIONS
  In our series of octogenarian patients, the LRA was a valid alternative for diagnostic procedures but its usage was not associated with a significant reduction in procedural and fluoroscopy times compared to the RRA.
authors.affiliation: Thorax Institute, Division of Cardiology, Interventional Cardiology Program, Hospital Clinic of Barcelona, Barcelona, Spain. freixa@clinic.ub.es
authors.forename: Xavier
authors.initials: X
authors.lastname: Freixa
authors.forename: Marc
authors.initials: M
authors.lastname: Trilla
authors.forename: Matías
authors.initials: M
authors.lastname: Feldman
authors.forename: Marcelo
authors.initials: M
authors.lastname: Jiménez
authors.forename: Amadeo
authors.initials: A
authors.lastname: Betriu
authors.forename: Mónica
authors.initials: M
authors.lastname: Masotti
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D062906:Cardiac Catheters; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D017534:Radial Artery; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain; D013997:Time Factors