Transradial Approach (Left vs Right) and Procedural Times During Percutaneous Coronary Procedures: TALENT Study
What is the safety and efficacy of the left radial approach (LRA) compared with right radial approach (RRA) for coronary procedures?
From January 2009 to December 2009, in two hospitals, 1,540 patients were randomized to RRA (770 patients) or LRA (770 patients) for percutaneous coronary procedures. The primary endpoint was fluoroscopy time for coronary angiography (CA) and for percutaneous coronary intervention (PCI) evaluated independently. Prespecified subgroup analyses according to patient age and operator experience were planned.
In 1,467 patients (732 RRA and 735 LRA), a CA (diagnostic group) was performed, and in 688 (344 each for RRA and LRA), a PCI was performed. In the diagnostic group, LRA was associated with significantly lower fluoroscopy time (149 seconds; interquartile range [IQR], 95-270 seconds) and dose area product fluoroscopy (10.7 Gy cm2; IQR, 6-20.5 Gy cm2) compared with the RRA (168 seconds; IQR, 110-277 seconds; p = 0.0025 and 12.1 Gy cm2; IQR, 7-23.8; Gy cm2; p = 0.004, respectively). In the PCI group, there were no significant differences in fluoroscopy time (614 seconds; IQR, 367-1,087 seconds for LRA and 695 seconds; IQR, 415-1,235 seconds; p = 0.087 for RRA) and dose area product fluoroscopy (53.7 Gy cm2; IQR, 29-101 Gy cm2 for LRA and 63.1 Gy cm2; IQR, 31-119 Gy cm2; p = 0.17 for RRA). According to subgroup analyses, the differences between LRA and RRA were confined to older patients (≥70 years old) and to operators in training.
The authors concluded that the LRA for coronary diagnostic procedures is associated with lower fluoroscopy time and radiation dose adsorbed by patients compared with the RRA.
The study suggests that LRA for CA is associated with slight, but significant lower fluoroscopy time and lower radiation dose compared with the RRA. The left radial advantage seems to be confined to operators at the beginning of their learning curve, and seems to be more evident in older patients. The investigators used preshaped catheters for the transfemoral approach (Judkins curves) for radial catheterization, and it is possible that the use of preshaped catheters dedicated for the transradial approach may reduce the differences between LRAs and RRAs.
Keywords: Fluoroscopy, Coronary Angiography, Catheterization, Catheters, Radiation Dosage, Percutaneous Coronary Intervention
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