title: Left radial access for percutaneous coronary procedures: from neglected to performer? A meta-analysis of 14 studies including 7,603 procedures.
abstract: BACKGROUND
  Radial artery is currently the preferred access route for percutaneous coronary procedures. The major reason for its widespread use is the higher safety as compared to femoral artery access. Initially most centers have preferred the right radial artery. However, an advantage has been hypothesized for the left radial access especially for the more favorable vascular anatomy. For this reason, the aim of the present meta-analysis was to compare procedural performance of left and right radial artery access for percutaneous coronary interventions.
  
  
  METHODS
  We performed a meta-analysis of all available studies comparing right radial access and left radial access for coronary procedures. Corrected standardized mean difference (Hedges' g) and odds ratios (OR) were used to estimate the mean effect respectively for continuous variables and frequencies.
  
  
  RESULTS
  The present analysis includes 14 studies with 7603 procedures. A statistically significant difference in the amount of contrast medium utilized for the procedure (0.12 [0.03-0.21], p=0.007), in fluoroscopy time (0.16 [0.06-0.25], p=0.001) and in total procedural time (0.22 [0.11; 0.33], p<0.001) was observed in favor of the left radial access. At the same time, no significant difference in the rate of procedural failure was observed between the right and the left radial access routes (OR=1.01 [0.70-1.47], p=0.942).
  
  
  CONCLUSIONS
  Left radial access is associated to a modest yet significant reduction in fluoroscopy time, procedural time and in the amount of contrast medium administered, while failure rate was similar between right and left radial approaches.
authors: Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.
authors: Salvatore
authors: S
authors: De Rosa
authors: Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.
authors: Daniele
authors: D
authors: Torella
authors: Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.
authors: Gianluca
authors: G
authors: Caiazzo
authors: Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.
authors: Salvatore
authors: S
authors: Giampà
authors: Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy; URT-CNR, Department of Medicine, Consiglio Nazionale delle Ricerche, Catanzaro, Italy.
authors: Ciro
authors: C
authors: Indolfi
mesh_terms: D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D017534:Radial Artery / Q000000981:diagnostic imaging* / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D016896:Treatment Outcome
keywords: Meta-analysis; Procedural performance; Radial access