Objectives Marked vascular tortuosity is more common in right radial approach (RRA) than that in left radial approach (LRA) and may lead to coronary procedure failure, especially in the elderly or female patients. However, the efficacy of LRA has not been adequately evaluated in older female patients. Therefore, we compared the feasibility and safety between LRA and RRA in older female patients undergoing coronary angiography.
Methods Of 1060 consecutive patients undergoing coronary angiography, we identified 146 female patients age ≥70 years old. These patients were divided into LRA (n = 61) and RRA (n = 85)group. Coronary procedure success, coronary time defined as the time from radial sheath insertion to first cineangiography recording, time to diagnosis defined as the time from first cineangiography recording to the end of coronary angiography, total procedure time, fluoroscopy time, dose of radiation including cumulative air kerma (CAK) and CAK dose area product (CAKDAP), and contrast volume were compared between both groups.
Results The baseline characteristics of the patients were similar between the two groups. Coronary procedural success was 56 of 61 (92%) for LRA and 80 of 85 (94%) for RRA. No significant differences were detected in coronary time (LRA195 ± 157 sec vs RRA 213 ± 193 sec, p = 0.58), total procedure time(LRA 15 ± 7min vs RRA 14 ± 6 min, p = 0.45), fluoroscopy time (LRA 4 ± 3 min vs RRA 4 ± 3 min, p = 0.96), CAK(LRA 309 ± 181mGy vs RRA 282 ± 169 mGy, p = 0.38) and CAK DAP (LRA; 28800 ± 16788mGycm2 vs RRA 24900 ± 13855 mGycm2,p = 0.15) between both groups. Nevertheless, contrast volume was significantly greater in LRA group than that in RRA group (65 ± 15 ml vs 60 ± 11 ml, p = 0.032). There was also a trend toward longer time to diagnosis in the LRA group (383 ± 220 sec vs 321 ± 151 sec, p = 0.054).
Conclusions Although coronary procedural success rate is similar, LRA may be more time and contrast consume in older female patients undergoing coronary angiography compared to RRA.