title: Effect of Vascular Access Site Choice on Radiation Exposure During Coronary Angiography: The REVERE Trial (Randomized Evaluation of Vascular Entry Site and Radiation Exposure).
abstract: OBJECTIVE
  This study sought to perform a randomized noninferiority trial of radiation exposure during cardiac catheterization comparing femoral access (FA) with left radial access (LRA) and right radial access (RRA).
  
  
  BACKGROUND
  Increased radiation exposure with radial approach compared with femoral approach remains a controversial issue.
  
  
  METHODS
  This study randomized 1,493 patients undergoing cardiac catheterization at a tertiary care center to FA, LRA, and RRA in a 1:1:1 fashion. The primary endpoint was air kerma. The secondary endpoints included dose-area product, fluoroscopy time and operator dose per procedure, number of cineangiograms, and number of catheters.
  
  
  RESULTS
  Baseline and procedural characteristics were similar among groups. No significant differences were observed in air kerma (medians: FA: 421 mGy [interquartile range (IQR): 337 to 574 mGy], LRA: 454 mGy [IQR: 331 to 643 mGy], and RRA: 483 mGy [IQR: 382 to 592 mGy], p = 0.146), dose-area product (medians: FA: 25.5 Gy cm(2) [IQR: 19.6 to 34.5 Gy cm(2)], LRA: 26.6 Gy cm(2) [IQR: 19.5 to 37.5 Gy cm(2)], and RRA: 27.7 Gy cm(2) [IQR: 21.9 to 34.4 Gy cm(2)], p = 0.40), or fluoroscopy time (medians: FA: 1.3 min [IQR: 1.0 to 1.7 min], LRA: 1.3 min [IQR: 1.0 to 1.7 min], and RRA: 1.32 min [IQR: 1.0 to 1.7 min], p = 0.19) among the 3 access sites. Median operator exposure was higher in the LRA group (3 mrem [IQR: 2 to 5 mrem], p = 0.001 vs. FA, and p = 0.0001 vs. RRA) compared with the FA (2 mrem [IQR: 2 to 4 mrem] and RRA groups (3 mrem [IQR: 2 to 5 mrem]).
  
  
  CONCLUSIONS
  Radiation exposure to patients was similar during diagnostic coronary angiography with FA, RRA, and LRA. However, LRA was associated with significantly higher operator radiation exposure than were FA and RRA procedures. (Randomized Evaluation of Vascular Entry Site and Radiation Exposure [REVERE]; NCT01677481).
authors.affiliation: Wright Center for Graduate Medical Education, Commonwealth Medical College, Scranton, Pennsylvania. Electronic address: pancholys@gmail.com.
authors.forename: Samir B
authors.initials: SB
authors.lastname: Pancholy
authors.affiliation: Seth N.H.L Municipal Medical College, Ahmedabad, India.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Joshi
authors.affiliation: Department of Interventional Cardiology, Apex Heart Institute, Ahmedabad, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Shah
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Rao
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Olivier F
authors.initials: OF
authors.lastname: Bertrand
authors.affiliation: Apex Heart Institute, Ahmedabad, India.
authors.forename: Tejas M
authors.initials: TM
authors.lastname: Patel
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D062906:Cardiac Catheters; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002932:Cineangiography; D017023:Coronary Angiography / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005263:Femoral Artery; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000517:prevention & control; D011677:Punctures; D017534:Radial Artery; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000517:prevention & control; D062606:Tertiary Care Centers
keywords: coronary angiography; operator experience; radiation exposure; transradial access