A Comparison of Image Quality Using Radial vs Femoral Approaches in Patients Undergoing Diagnostic Coronary Angiography

J Invasive Cardiol. 2018 Nov;30(11):411-415. Epub 2018 Aug 15.

Abstract

Introduction: Radial access for diagnostic coronary angiography (CAG) has gained traction in recent years over the femoral artery approach, but difference in image quality has not been extensively studied. This study aims to compare image quality and diagnostic value in radial vs femoral access in patients undergoing invasive CAG.

Methods: This is a retrospective study of 200 patients (100 radial and 100 femoral) undergoing CAG at an experienced center from 2014 to 2015. The primary endpoint was angiographic image quality, and secondary endpoints were proportion of non-diagnostic images and patient radiation dose. Image quality was assessed by four experienced angiographers using a quantitative scale. Mean differences in scores were compared as well as proportion of non-diagnostic images produced.

Results: Radial access produced images that were significantly poorer than femoral access when viewing the left coronary artery (2.65 ± 0.04 vs 2.79 ± 0.03; P<.01). This difference remained significant after adjusting for age, gender, and catheter size (P=.04). There was no significant difference in image quality between the radial and femoral group when viewing the right coronary artery (2.91 ± 0.03 vs 2.84 ± 0.04; P=.11). There was a higher proportion of non-diagnostic images produced by radial access than femoral (3.23% vs 2.02%; P<.01) and radial access resulted in higher patient radiation doses (832.81 ± 49.59 mGy vs 645.69 ± 35.46 mGy; P<.01).

Conclusion: Radial access produces poorer angiographic image quality and exposes patients to greater radiation compared to femoral access in contemporary practice. An awareness of these limitations is important when selecting mode of access in patients undergoing diagnostic CAG.

Keywords: CAG; coronary angiography; image quality; radial access.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Catheterization, Peripheral / methods*
  • Coronary Angiography / methods
  • Coronary Angiography / standards*
  • Coronary Artery Disease / diagnosis*
  • Coronary Vessels / diagnostic imaging*
  • Female
  • Femoral Artery
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Radial Artery
  • Reproducibility of Results
  • Retrospective Studies
  • Vascular Access Devices*