J Cardiovasc Interv.  2022 Jul;1(3):115-123. 10.54912/jci.2021.0008.

Right Versus Left Radial Artery Access for Coronary Procedures: Efficacy Is More Dependent on an Operator Proficiency Than on the Access Site Selection

• Youn YJ
• Choi DH
• Park YJ
• Son JW
• Lee JW
• Ahn MS
• Ahn SG
• Kim JY
• Yoo BS
• Lee SH
• Yoon J

• KMID: 2561249
• DOI: http://doi.org/10.54912/jci.2021.0008

Abstract

Background
Right radial access (RRA) is the preferred despite the prevalence of subclavian artery tortuosity and prolonged fluoroscopy time during coronary procedures. This study aimed to evaluate the efficacy and learning curve of RRA in operators proficient with left radial access (LRA).
Methods
Three operators proficient with LRA were assigned to use RRA for the first 3 months (n = 162) and LRA for the following 3 months (n = 160). To evaluate the learning curve, each access site was divided into 3 periods based on enrollment month.
Results
There was no difference in access site crossover (3.1% vs. 1.2%; P = 0.448), whereas subclavian artery tortuosity (9.5% vs. 1.3%; P = 0.011), use of right diagnostic catheter ≥ 2 (9.4% vs. 2.5%; P = 0.010), access time (2.0 minutes vs. 1.0 minutes; P = 0.014), and fluoroscopy time (2.3 minutes vs. 1.5 minutes; P < 0.001) were significantly higher during RRA. However, gradual decreases in access time (minutes; 2.0, 2.0, and 1.0), fluoroscopy time (minutes; 2.5, 2.1, and 1.8), and use of right diagnostic catheter ≥ 2 (12.1%, 9.5%, and 2%) were observed each month during RRA despite a constant rate of subclavian artery tortuosity.
Conclusions
This study shows that proficiency with the selected radial access site might be more important than the access site used to perform the procedure effectively.

Keyword

Coronary angiography; Learning curve; Radial artery