Increased radiation exposure with transradial access for coronary procedures

Compared with the transfemoral approach, coronary angiography and percutaneous coronary intervention (PCI) performed via transradial access reduces rates of bleeding and vascular complications.  However, the potential for increased radiation exposure to patients and operators may be a barrier to the adoption of the transradial approach.  In this systematic review and meta-analysis of 24 published studies comparing transradial and transfemoral access for coronary angiography and PCI, the authors compared the differences in radiation exposure between access approaches as measured by fluoroscopy time (min) and kerma-area product (KAP, Gy cm2).  After a rigorous search to identify studies of coronary procedural access that reported radiation exposure, the authors found 24 published randomized controlled trials from 1996-2014 with 19,328 patients for analysis.  Comparing radiation exposure by access site strategy, the authors found a statistically significant increase in fluoroscopy time for diagnostic coronary angiography (DCA) (weighted mean difference [WMD]: 1.04 min [95% CI 0.84-1.24]) and PCI (WMD fluoroscopy time 1.15 min [95% CI 0.96–1.33]), while only a statistically significant increase in KAP for PCI (0.55 Gy cm2 [95% CI 0.08–1.02] but not DCA (1.72 Gy cm2 [95% CI −0.10 – 3.55]. In meta-regression analysis comparing differences in radiation exposure by year of study, differences in fluoroscopy time between transradial and transfemoral approaches decreased over time.  The analysis was limited by significant heterogeneity in the pooled studies (I2 > 75%).

 

Conclusion: This systematic review and meta-analysis suggests transradial access for coronary procedures is associated with a small increase in radiation exposure.  However, this gap in radiation exposure between transradial and transfemoral access has closed over time, presumably reflecting increased operator experience with transradial access.  Further, the clinical significance of the observed difference in radiation exposure is unclear. Given the benefits of transradial access for reducing rates of periprocedural complications, these findings should not discourage use of transradial access.  Instead, these findings emphasize the importance of continued attention to radiation safety as operators adopt a transradial approach.

 

Summarized by Javier A. Valle and Steven M. Bradley

 

Plourde G, Pancholy SB, Nolan J, Jolly S, Rao SV, et al. Radiation exposure in relation to the arterial access site used for diagnostic coronary angiography and percutaneous coronary intervention: a systematic review and meta-analysis

Lancet 2015; 386: 2192–203