CORONARY ANGIOGRAPHY BY THE LEFT RADIAL A PPROACH - A BICENTRIC PROSPECTIVE PILOT-STUDY

The aim of this study was to assess prospectively the feasibility, saf ety and quality of coronary angiography performed by a left radial art erial approach. The investigation was performed under local anesthesia with a Lidocaine gel using Judkins 5F catheter. A bolus of heparin wa s injected intravenously at the start of the procedure (no heparin in phase 0, 2 to 3.000 IU during phase 1 and 5.000 IU in phase 2). Betwee n March 1994 and January 1996, after exclusion of 108 patients (15.1 % ) mainly because of an abnormal Alien test, coronary angiography was c arried out in 540 patients aged 58.4 +/- 11.7 years, 85 % of whom were men. The failure rate was 8 %. The quality of opacification of the le ft coronary artery (scale 1 to 3) was 2.91 +/- 0.27 and of the right c oronary artery was 2.96 +/- 0.18. There were no complications during t he procedure. Analysis of the learning curve showed a failure rate dec reasing to less than 5 % after 60 procedures/operator. In the last 100 procedures, the failure rate felt to 3 %, the canulation time was 2.2 +/- 2.5 min, the duration of fluoroscopy was 6.5 +/- 3.9 min and the duration of the procedure was 17.5 +/- 4.7 min (14.7 +/- 3.8 min, p < 0.01, by the femoral approach). Clinical and Doppler ultrasonographic follow-up revealed one in-hospital complication (a spontaneously-regre ssive compressive haematoma). No clinical complications were observed at 3 months. Doppler ultrasonography showed the radial artery occlusio n rate to be 71 % in phase 0.32 % in phase 1 and 3.2 % in phase 2 (p < 0.0001). These results show that the Left radial arterial approach fo r coronary angiography is safe and effective but requires a period of training. A 5.000 IU dose of heparin limits the risk of radial artery occlusion to 3 %. The absence of complications in this large series wh ich included the training period and the patient comfort suggest that this technique may be an excellent alternative to the femoral approach and especially the brachial approach when the Allen test is normal.