Left Versus Right Radial Artery and Radiation Exposure in Patients With Predictors of Trans-radial Failure
Left Versus Right Radial Artery and Radiation Exposure in Patients With Predictors of Trans-radial Failure
The aim of this study is to measure radiation exposure during coronary angiography (CA) with
 a trans-radial approach (TRA), specifically comparing access via the left versus right radial
 artery in patients with suggested clinical predictors of TRA failure/difficult. These
 predictors include age >70, female gender, height <64 inches, and history of hypertension.The
 study also aims to determine difficulties encountered during left or right radial access in
 this specific patient population. A secondary aim is to compare the results of enrolled
 patients with a registry of patients where femoral access was obtained.

 Currently more than 1 million percutaneous coronary interventions (PCI) are performed in the
 United States annually. There is a growing trend to perform procedures utilizing the TRA due
 to recent data demonstrating decreased bleeding and access-site complications compared to the
 femoral approach. However, the TRA approach is also know to be associated with greater
 radiation exposure compared to the femoral approach. Furthermore, the TRA to catheterization
 may be difficult in certain populations because of anatomic considerations. Though
 traditionally completed via canalization of the right radial artery (RRA) due to feasibility
 with room setup, left radial artery (LRA) access may be superior due to the shorter distance
 needed to reach the ascending aorta and bypassing the tortuosity of the right subclavian
 artery. Given the benefits of the TRA, it is important to determine how left versus right
 radial artery access affects parameters of radiation exposure in addition to procedural
 difficulty.

 This study will be a prospective, randomized study of patients with suggested predictors of
 TRA failure/difficulty referred for coronary angiography. Patients referred for coronary
 angiography using the trans-radial approach will be randomly assigned to obtain arterial
 access via the right or left radial artery. A registry of patients referred for coronary
 angiography using the trans-femoral approach will be compiled. The primary outcome measure
 will be radiation exposure as measured by dose area product output from the coronary
 angiography system. Secondary measures will include the total fluoroscopy time, total dose of
 radiation, number of catheters used, and incidence of subclavian tortuosity. In addition,
 procedural complications and success rates will also be evaluated.
Inclusion Criteria:

 Patients referred for cardiac catheterization procedure with 3 out of the following 4
 characteristics: age ≥70 years, female gender, hypertensive, and ≤64 inches in height.

 Exclusion Criteria:

 Patients will be excluded if they 1) underwent prior CABG with utilization of an internal
 mammary artery, 2) have an abnormal Allen test, 3) require emergency cardiac
 catheterization, 4) are planned to undergo a staged PCI procedure, 5) do not consent or are
 unable to give consent, or 6) are participating in another competing study.