Management of patients undergoing coronary angiography or percutaneous coronary interventions through the left distal trans-radial artery approach compared to the right conventional trans-radial artery approach

Background: Lately, the alternative optimal approach for the access of the coronary artery was made through the left distal radial artery, either for diagnostic or interventional purposes. This study aimed to compare the safety and efficacy of the left distal trans-radial (ld-TRA) and conventional right trans-radial (RTRA) approaches for coronary procedures. Patients and Methods: This prospective cohort study was conducted on 100 patients who underwent coronary angiography and/or PCI in the Department of Cardiology of Beni-Suef University Hospital. Fifty patients underwent conventional right trans-radial access. The other fifty underwent left distal trans-radial approach from October 2018 to October 2019. The primary clinical outcomes were the complications at the blood vessel access site and the major induced adverse cardiac events. The secondary outcomes were the puncture time, the procedure time, the coronary cannulation time, the amount of dye injected, and the fluoroscopy time. Results there was an insignificant lower rate of crossover and complications in the ldTRA than in the RTRA. The coronary cannulation time was significantly lower in ldTRA (30 ± 7 seconds) than in RTRA (43 ± 11 seconds). Also, there was insignificant lower puncture time, duration of the procedure, amount of dye, and fluoroscopy time in the ldTRA than in the RTRA. Conclusion The access technique of the distal left radial artery is considered feasible and safe access for coronary interventions and angiography, with only a minor advantage over the right radial approach adding the benefit of the preservation of the radial artery for further revascularization procedures when needed.