Faisabilité et sécurité de l’abord radial droit pour l’angiographie des pontages mammaires internes gauches

Abstract

Background

The right radial approach has become the preferred access route for coronary angiography and percutaneous coronary intervention. However, its use for left internal mammary artery graft (LIMA) angiography in patients with prior coronary artery bypass grafting (CABG) remains controversial. This study aimed to assess the feasibility and safety of the right radial approach compared with the left radial and femoral approaches for LIMA graft angiography.

Methods

We compared feasibility criteria (LIMA visualization and selective engagement, procedure duration, contrast volume, and fluoroscopy time) and safety parameters during LIMA graft angiography, across right radial, left radial, and femoral access in 760 post-CABG patients.

Results

LIMA visualization was successful in 92% of cases via the right radial access, compared to 96% for both the left radial and femoral access (p = 0.158). Selective LIMA engagement was significantly lower with the right radial access (61%) than with the left radial (86%) and femoral (78%) access (p < 0.0001). No significant differences were observed in procedure duration, fluoroscopy time, or contrast volume. Haemorrhagic complications were significantly less frequent with the right radial approach (0%) compared to the femoral approach (6%, p = 0.0001). The rates of radial artery spasm and occlusion were similar between the two radial access groups.

Conclusion

The right radial access is a safe and effective alternative for LIMA graft angiography in post-CABG patients. It represents a valuable option when the left radial artery is unavailable, allowing to avoid the femoral access and its associated complications.