Left or Right Transradial Approach? Comparing Radiation Exposure in Coronary Procedures

Radiation exposure during percutaneous procedures is a problem both for patients and operators. The transradial is currently the preferred approach, vs. femoral; however, whether the left (LRA) or right (RRA) approach is associated to lower radiation burden remains controversial. This meta-analysis aimed at systematically comparing radiation exposure between these two during diagnostic and therapeutic coronary procedures. 

The primary outcome was difference in fluoroscopy time (FT) and dose-area product (DAP) between LRA and RRA. Secondary outcomes included cumulative air kerma (CAK) and operator radiation exposure, assessed as absolute dose and DAP thorax dose.

There was a systematic review following PRISMA recommendations, including randomized clinical trials published until July 2025. 19 studies were looked at, with total 9,443 patients undergoing coronary angiogram/ and or percutaneous coronary intervention. 4,584 of these patients were treated with RRA and 4,607 with LRA. These trials were conducted in Asia, Europe, and North America, and included operators with different expertise. 

Outcomes showed LRA was associated with a statistically significant fluoroscopy time vs. RRA (standardized mean difference [SMD] 0.105, 95% confidence interval: 0.037-0.174, p = 0.003). Also, DAP resulted significantly lower with LRA vs. RRA (SMD 0.09, 95% CI: 0.016-0.163, p = 0.017). 

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In contrast, there were no significant differences in cumulative air kerma (CAK) between groups (SMD 0.067, 95% CI: -0.001 to 0.135, p = 0.055). As regards operator radiation exposure, LRA was associated with significant reduction both of absolute and DAP normalized thorax doses (SMD 0.297, 95% CI: 0.023-0.71, p = 0.034; SMD 0.392, 95% CI: 0.251-0.533, p = 0.000, respectively). 

Conclusion

This meta-analysis shows the LRA is associated with lower fluoroscopy time, DAP and operator radiation exposure vs RRA during percutaneous coronary procedures, with no significant difference in CAK. These findings support LRA as a potentially safer strategy as to radiation exposure. 

Original Title: Comparison of Radiation Exposure to X-Ray Between Left and Right Radial Approach During Coronary Procedures: A Meta-Analysis Based on Randomized Controlled Trials.

Reference: Youjin Zhu, et al. Department of Cardiovascular Medicine, Institute of Cardiovascular Disease, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China. Catheterization and Cardiovascular Interventions, 2025.