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REVERE: Left radial access linked to increased operator radiation exposure
Patient exposure to radiation appears similar during cardiac catheterization with femoral access, left radial access and right radial access, but operator exposure to radiation may be higher with left radial access.
Researchers for the REVERE study randomly assigned 1,493 patients undergoing cardiac catheterization to femoral access, left radial access or right radial access.
The primary endpoint, air kerma, was similar in the femoral group (median, 421 mGy), left radial group (454 mGy) and right radial group (483 mGy; P = .146 for comparison). The researchers also observed no significant differences in dose-area product (femoral, 25.5 Gy cm2; left radial, 26.6 Gy cm2; right radial, 27.7 Gy cm2; P = .4 for comparison). The median fluoroscopy time was about 1.3 minutes in all three access-site groups (P = .19 for comparison).
Operator exposure to radiation was not significantly different in the femoral group (2 mrem) and right radial group (3 mrem), but median operator exposure was increased in the left radial group compared with the femoral and right radial groups (3 mrem; P = .001 vs. femoral access; P = .0001 vs. right radial access), according to the results.
“The results of this randomized controlled study demonstrate that access site choice is not associated with significant difference in radiation exposure for patients undergoing coronary angiography,” Samir B. Pancholy, MD, from the Wright Center for Graduate Medical Education, Commonwealth Medical College, Scranton, Pennsylvania, and colleagues concluded.
Drivers of radiation exposure identified in the study included patient age, sex, weight, number of cineangiographic acquisitions, number of catheters used and operator experience.
“Increasing operator experience continues to improve radiation use for all access sites, including femoral access. Operator radiation exposure is likely a function of the operator’s distance from the radiation source and shielding, hence in a catheterization laboratory setup favoring right-sided procedures, it is higher with left radial access,” the researchers wrote. – by Rob Volansky
Disclosure: Pancholy reports consulting for Terumo Medical. Another researcher reports receiving consultant fees/honoraria from Terumo Medical. The other researchers report no relevant financial disclosures.