Comparative efficacy and safety of the left versus right radial approach for percutaneous coronary procedures: a meta-analysis including 6870 patients

The radial approach is widely used in the treatment of patients with coronary arterydisease. We conducted a meta-analysis of published results on the efficacy and safetyof the left and right radial approaches in patients undergoing percutaneous coronaryprocedures. A systematic search of reference databases was conducted, and data from14 randomized controlled trials involving 6870 participants were analyzed. The leftradial approach was associated with significant reductions in fluoroscopy time[standardized mean difference (SMD)=-0.14, 95% confidence interval (CI)=-0.19 to-0.09; P<0.00001] and contrast volume (SMD=-0.07, 95%CI=-0.12 to -0.02; P=0.009).There were no significant differences in rate of procedural failure of the left andthe right radial approaches [risk ratios (RR)=0.98; 95%CI=0.77-1.25; P=0.88] orprocedural time (SMD=-0.05, 95%CI=0.17-0.06; P=0.38). Tortuosity of the subclavianartery (RR=0.27, 95%CI=0.14-0.50; P<0.0001) was reported more frequently with theright radial approach. A greater number of catheters were used with the left thanwith the right radial approach (SMD=0.25, 95%CI=0.04-0.46; P=0.02). We conclude thatthe left radial approach is as safe as the right radial approach, and that the leftradial approach should be recommended for use in percutaneous coronary procedures,especially in percutaneous coronary angiograms.