European Heart Journal Advance Access originally published online on July 9, 2008
European Heart Journal 2008 29(18):2316-2317; doi:10.1093/eurheartj/ehn332
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Radial artery catheterization and radiological exposure
Interventional Cardiology Unit
S. Filippo Neri Hospital
Via Borgorose 5
Rome 00189
Italy
Tel: +39 33 062 581
Fax: +39 06 33 062 516
Email: pristipino.c{at}libero.it
With interest I reviewed the article recently published by Brasselet et al., 1 showing the data of a higher radiation exposure in the invasive procedures performed by radial artery catheterization (RAC), compared with femoral artery catheterization (FAC).
However, owing to a number of possible biases, I think that their results should be generalized with extreme caution.
First, the study was performed in a moderate volume institution. We recently showed that among experienced operators in RAC, those with the highest volumes of procedures achieved the lowest procedural failure rate in the ‘real world’.2 Therefore, despite their expertise in RAC, the operators in this study might not have performed a sufficient RAC volume to yield the best feasibility. This may explain the longer procedure duration and X-ray exposures reported by the authors in contrast to the aforementioned trial performed in a high volume centre.2 The consequence would be that a more frequent use of RAC could imply safer procedures for both patients and operators.
Secondly, radiation exposure may significantly differ in left vs. right RAC. In fact, performing RAC by the left arm has two main consequences: (i) the need of reaching the left arm by hanging out beyond the leaded glass causes a wider exposure of the operator, (ii) the uncomfortable position of the operator may cause a prolongation of the procedure itself in all the stages of the intervention. Therefore, a possible higher prevalence of left RAC in this study may have significantly biased the results. Unfortunately, the authors do not provide any data regarding this issue.
Thirdly, relative to the patient's body, the RAC and FAC need different positions and angulations of the operator with respect to the direct and reflected X-ray beams, resulting in different exposures. As a consequence, any study aimed at assessing the exposure safety of the two arterial approaches should compare the best specific protection strategies for RAC and FAC, which are obviously not the same.
Taken together, these considerations imply that, in contrast to the authors' conclusions, it could be possible to achieve the major clinical benefits of RAC without loosing a sufficient radiological safety by (i) maximizing its use among operators and centres and (ii) identifying specific technical features and protection devices which best lessen X-ray exposure.
References
- Brasselet C, Blanpain T, Tassan-Mangina S, Deschildre A, Duval S, Vitry F, Gaillot-Petit N, Clément JP, Metz D. Comparison of operator radiation exposure with optimized radiation protection devices during coronary angiograms and ad hoc percutaneous coronary interventions by radial and femoral routes. Eur Heart J (2008) 29:63–70.
[Abstract/Free Full Text] - Pristipino C, Pelliccia F, Granatelli A, Pasceri V, Roncella A, Speciale G, Hassan T, Richichi G. Comparison of access-related bleeding complications in women versus men undergoing percutaneous coronary catheterization using radial versus femoral artery. Am J Cardiol (2007) 99:1216–1221.[CrossRef][Web of Science][Medline]
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