title: Comparison of transradial coronary procedures via right radial versus left radial artery approach: A meta-analysis.
abstract: BACKGROUND
  Coronary angiography and angioplasty via transradial approach is shown to be associated with significant reduction in access site complications. Due to a lack of sufficient data, the use of the right or left radial approach is still operator-dependent. We performed a meta-analysis of prospective randomized studies to compare right versus left radial artery approach for coronary procedures.
  
  
  METHODS
  We found 12 randomized studies meeting the predetermined inclusion criteria. A total of 6,450 patients were included in the meta-analysis of which 3,217 patients underwent coronary procedures via right radial approach and 3,233 patients via left radial approach. The primary endpoint was the comparison of fluoroscopy time, procedure time, contrast use and cross-over rates between two radial approaches.
  
  
  RESULTS
  Pooled analysis of the included studies showed a similar rate of cross-over events (4.2% for right radial approach vs. 4.1% for left radial approach, odds ratio (OR)=1.08, P = 0.68), and similar total procedure times (18.8 ± 10.3 min vs. 18.1 ± 10.0 min, standard difference (SD) of the mean = 0.09, P = 0.162) between the two radial approaches. However, the right radial approach was found to be associated with minimally longer fluoroscopy times (5.8 ± 4.4 min vs. 5.3 ± 4.2 min, SD of the mean = 0.157, P < 0.001) and greater contrast use (84 ± 35 mL vs. 82 ± 34 mL, SD of the mean = 0.082, P = 0.003). Access site complications and the incidence of stroke were similar between two radial approaches.
  
  
  CONCLUSIONS
  Our meta-analysis suggests a small but statistically significant difference in terms of contrast use and fluoroscopy time in favor of coronary procedures performed via left radial approach in comparison to right radial approach without any significant difference in access site or other procedural complications between the two radial approaches. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Cardiology, Virginia Commonwealth University Hospital, Richmond, Virginia.
authors.forename: Rachit M
authors.initials: RM
authors.lastname: Shah
authors.affiliation: Department of Cardiology, Virginia Commonwealth University Hospital, Richmond, Virginia.
authors.forename: Dhavalkumar
authors.initials: D
authors.lastname: Patel
authors.affiliation: Department of Cardiology, Virginia Commonwealth University Hospital, Richmond, Virginia.
authors.forename: Antonio
authors.initials: A
authors.lastname: Abbate
authors.affiliation: Department of Cardiology, Virginia Commonwealth University Hospital, Richmond, Virginia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Cowley
authors.affiliation: Department of Cardiology, Virginia Commonwealth University Hospital, Richmond, Virginia.|Department of Cardiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia.
authors.forename: Ion S
authors.initials: IS
authors.lastname: Jovin
mesh_terms: D000368:Aged; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods*; D016009:Chi-Square Distribution; D003287:Contrast Media / Q000008:administration & dosage; D017023:Coronary Angiography / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D011677:Punctures; D017534:Radial Artery; D011829:Radiation Dosage; D000069079:Radiation Exposure; D015641:Radiography, Interventional; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media
keywords: Transradial; angiography; angioplasty; contrast; coronary procedures; cross-over events; fluoroscopy time; procedure time