No major difference in radiation exposure between transradial, transfemoral access in PCI
Data from a meta-analysis show no difference in fluoroscopy time between transradial vs. transfemoral access for PCI; however, diagnostic coronary angiography continues to marginally favor transfemoral access, researchers reported.
“The difference in radiation exposure between transfemoral and transradial procedures has decreased over the years; in the contemporary era, the difference is so small that it is hardly relevant,” Samir B. Pancholy, MD, FAHA, FACP, FACC, FSCAI, professor of medicine at Geisinger Commonwealth School of Medicine and program director of the fellowship in cardiovascular diseases at The Wright Center for Graduate Medical Education in Scranton, Pennsylvania, told Healio. “In experienced laboratories and with experienced operators, the difference in radiation exposure between radial and femoral procedures has disappeared.”
In a systematic review and meta-analysis, Pancholy and colleagues compared radiation exposure between the two access sites to evaluate differences in radiation metrics between the two access sites after 2014. Additionally, researchers assessed radiation exposure between the two access sites when comparing studies performed in United States vs. outside the U.S. The researchers also assessed temporal trends in radiation exposure between the two access sites during the past 3 decades using published randomized controlled trials data. The coprimary outcome measures for the pooled analysis were the radiation metrics of fluoroscopy time and dose area product.
The findings were published in Catheterization and Cardiovascular Interventions.
Data from eight randomized controlled trials published since 2014 with 11,611 participants showed the weighted mean difference of fluoroscopy time was 0.62 minutes (95% CI, 0.08-1.17; P = .023) in favor of transfemoral access. The weighted mean difference in dose area product (n = 9,169 participants) was 1.94 Gy.cm2 (95% CI, –2.1 to 5.9; P = .35), showing no significant difference. Pooled data from observational studies and randomized controlled trials with 83,990 participants demonstrated a similar trend, according to researchers.
In secondary analyses, the weighted mean difference in fluoroscopy time for patients who underwent diagnostic coronary angiography was 0.75 minutes (95% CI, 0.11-1.37; P = .02) in favor for transfemoral access; however, for patients who underwent PCI, there was no difference in fluoroscopy time between the two access sites.
For studies conducted outside the U.S. (1995-2021), the weighted mean difference for fluoroscopy time between transradial and transfemoral access was 0.88 minutes (95% CI, 0.67-1.09; P = .005) vs. 2.1 minutes (95% CI, 1.38-2.8; P = .005) for studies conducted within the U.S., favoring transfemoral access.
Meta‐regression analyses also showed a declining weighted mean difference for fluoroscopy time between transradial and transfemoral access, falling from 1.6 minutes in 1996 to 0.5 minutes in 2020.
“Given the tremendous benefits of radial access compared with femoral access, cardiologists should not shy away from offering radial access to patients for their cardiac procedures because of concerns for an increase in radiation exposure,” Pancholy told Healio. “We need to strive to develop technologies and techniques to lower the global radiation burden with cardiac and peripheral procedures. Radial access may have potential to actually decrease operator radiation exposure.”
For more information:
Samir B. Pancholy, MD, FAHA, FACP, FACC, FSCAI, can be reached at pancholy8@gmail.com.
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