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Left Distal Radial Artery Access for Coronary Angiography and Interventions: A 12-Month All-Comers Study. | LitMetric

AI Article Synopsis

  • Interventional cardiologists often prefer the right radial artery for procedures, but using the left radial artery (preferably via the snuffbox) has its own benefits, like lower occlusion rates and easier hemostasis.
  • In a study of 2034 patients needing coronary catheterization, the left distal radial artery (ldRA) was successfully used in 1977 cases, showing a procedural failure rate of 9.9%.
  • The failure rate decreased significantly after initial cases, with a weak pulse being the strongest predictor of failure, but overall, the ldRA approach proved to be effective and safe over a 12-month period.

Article Abstract

Background: Interventional cardiologists prefer the right radial artery (RA) approach for coronary angiography and interventions, mainly for ergonomic reasons. However, the use of the left RA presents certain advantages, and the snuffbox approach has further potential advantages, including lower probability for RA occlusion, avoidance of direct puncture of the RA (thus maintaining its suitability for use as a graft), as well as easier and faster hemostasis.

Methods: Consecutive patients scheduled for coronary catheterization were included, using the left distal RA (ldRA) in the anatomical snuffbox as the default vascular access site.

Results: Out of 2034 consecutive cases, the ldRA was used as initial vascular access in 1977 patients (97.2%). The procedural failure rate was 9.9% (21.9% inability to puncture the artery, 75.0% inability to advance the wire, 3.1% other reasons). There was a sharp decrease in failure rate after about the first 200 cases (20.8% in the first decile vs 8.7% throughout the rest of the caseload; P<.001). No or very weak palpable pulse was the most important predictor of failure (odds ratio, 16.0; 95% confidence interval, 11.2-23.1; P<.001), in addition to older age, small stature, and female gender (although, after adjustment for height, the latter was no longer significant).

Conclusion: In a large series of consecutive patients scheduled for left heart catheterization, through a period of 12 months, with virtually no exclusions except those few imposed by anatomy or compelling clinical needs, the ldRA arterial access approach was shown to be highly effective, feasible, and safe.

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Source
http://dx.doi.org/10.25270/jic/21.00331DOI Listing

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