Chapter 10: Left vs. Right Radial Access

While operators can perform transradial access by using both the right and left radial access, most prefer the right approach mainly for two reasons: it is similar to the transfemoral approach and it is more comfortable for the operator. However, there are some important advantages of using the left transradial approach (Table 1) and consequently the knowledge of this approach can be of great interest, especially in particular settings.

Coronary Ostium Cannulation and Catheters

The technique of catheter manipulation in the right and left radial access is similar, but there are some differences that should be kept in mind. In the right radial access, the catheter has to pass through the right subclavian artery, but also through the brachiocephalic trunk before reaching the aortic root. At the level of these two areas of bifurcation the catheters must be rotated to afford the S-shaped geometry of the subclavian- innominate-aorta axis. The technical difficulty of this maneuver is increased, especially in patients with marked atherosclerotic artery disease.

Contradictory to the right side anatomy, the left subclavian artery arises directly from the aorta and the catheters inserted through the left radial access reach the ascending aorta following a straighter path. Moreover, the manipulation in the left radial access is very similar to that of the transfemoral approach, resulting in less complex catheter movement and greater catheter control.

Alessandro Sciahbasi, MD