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Left radial approach preferable to right for percutaneous coronary angiography

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – During transradial percutaneous coronary angiography, access through the left arm requires less fluoroscopy time and radiation dose than access through the right arm, physicians in Italy report. The differences are particularly notable among inexperienced operators and older patients.

These differences may reflect a higher degree of subclavian tortuosity in the right radial approach (RRA), the investigators suggest in their paper, published online December 17th in the American Heart Journal.

The TALENT study, conducted at two centers in Rome in 2009, included 1540 patients undergoing transradial procedures: 1467 who had coronary angiography and 688 who had percutaneous coronary intervention (PCI), either after angiography or as a stand-alone procedure.

First author Dr. Alessandro Sciahbasi, from UO Cardiologicia, Policlinico Casilino-ASL RMB, and his colleagues (10 expert operators and six fellows) randomly assigned patients in a one-to-one ratio to an RRA or a left radial approach (LRA).

In the angiography group, fluoroscopy time was longer with the RRA (median 168 vs 149 seconds, p = 0.0025). Similarly, the radiation dose absorbed by the patients was 12.1 gray cm