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Less operator radiation exposure reported with left vs. right radial access
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Left radial access yielded more operator discomfort but less operator radiation exposure than the right radial approach of both diagnostic interventions and PCI, according to recent findings.
The aim of the study was to evaluate whether radiation exposure and operator discomfort were different or similar for the left radial approach compared with the right radial approach. The researchers suggested that the transradial approach is becoming more prevalent, but that most of these interventions are performed with the right radial approach. They added that the left radial approach may carry associations with physical discomfort and increases in radiation exposure among operators.
The current study included five operators and 100 patients. Patients were randomly assigned left or right radial access — based on individual randomization processes instituted independently by each of the operators — and were stratified by obesity status.
Operators were outfitted with external radiation dosimeter badges on the head and thyroid and internal badges on the sternum. The researchers evaluated operator physical discomfort during vascular access and after completion of the procedure using a 0 to 10 scale, with 0 being no discomfort and 10 being very severe discomfort. A score of >4 was considered moderate to severe physical discomfort.
Baseline and procedural variables were similar between the two groups.
A significant increase in external radiation exposure occurred with the right radial approach compared with the left radial approach. For the head sensor, the median exposure was 6.12 (interquartile range [IQR], 2.6-16.6) mRems for right access and 12 (IQR, 6.4-22) mRems for the left (P=.02). Thyroid badge readings were 10.1 (IQR, 4.3-25) mRems for the right and 18.7 (IQR, 11-38) mRems for the left (P=.001).
Left radial access was associated with a 22% rate of discomfort during access compared with 4% for right radial access (P=.017). However, during the procedure, the discomfort rates were similar between the two groups, with 10% experiencing discomfort in the left approach and 4% experiencing discomfort with the right approach (P=.43). The researchers attributed this difference almost entirely to obese patients, with discomfort occurring in 30% for the left approach and 3.7% for the right approach in this population (P=.005).
“[Left radial access] is as effective as [right radial access], showing a safer profile with decreased radiation exposure to the operator, at the expense of more operator discomfort only during vascular access and limited to obese patients,” the researchers concluded.
Disclosure: The researchers report financial disclosures with Abbott Vascular, AstraZeneca, Bristol-Myers Squibb, Daiichi Sankyo, Eli Lilly, Esther and King Biomedical Research Grant, Evolva, GlaxoSmithKline, Incand PLx Pharma, Johnson & Johnson, Merck, Otsuka, Sanofi-Aventis, St. Jude, Sunovion and The Medicines Company.
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