Operator radiation exposure comparing left-radial artery and right-radial artery approaches: A systematic review and meta-analysis.

BACKGROUND

The radial artery approach is the predominant access site for percutaneous coronary interventions (PCI) due to its safety profile. Most centers prefer the right-radial artery approach (RRA) due to historical laboratory configurations. However, a reduction in operator radiation exposure (ORE) has been theorized for the left-radial artery approach (LRA) due to better shielding and more favorable subclavian artery anatomy.

OBJECTIVES

To compare ORE between the LRA and RRA during cardiac catheterization.

METHODS

We performed a meta-analysis of ORE comparing LRA and RRA. The ratio of means (ROM) was used to estimate the mean effect size.

RESULTS

This analysis includes 10 studies with 5,168 procedures (LRA, n = 2,410 vs RRA, n = 2,758). Cumulative ORE favored the LRA with lower levels at the thorax (ROM = 0.68, 95% CI: 0.52, 0.88, P <.001), left wrist (ROM = 0.64, 95% CI: 0.45, 0.93, P = .02), and neck (ROM = 0.68, 95% CI: 0.53, 0.86, P <.001). Cumulative ORE did not favor either the LRA or RRA at the left eye (ROM = 0.83, 95% CI: 0.63, 1.11, P = .22). Heterogeneity was high for thorax, left eye, and left wrist but not for neck. Possible publication bias was not present for thorax, left eye, and neck while left wrist had possible publication bias (Egger test: P = .02).

CONCLUSIONS

We recommend that the LRA should be the primary access site for operators in order to reduce ORE in laboratories with standard shielding configurations.