Transulnar Versus Transradial Access for Coronary Angiography and Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Controlled Trials

Objectives: To compare the outcomes of transulnar access (TUA) versus transradial access (TRA) for coronary angiography (CA) and percutaneous coronary intervention (PCI).

Background: TUA has emerged as an alternative access site in patients who fail TRA or not candidates for it. Data comparing both approaches have been limited.

Methods: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) that compared outcomes of TUA versus TRA for CA and/or PCI.

Results: Data from seven RCTs, with 5721 patients (TUA = 2874 and TRA = 2847), were analyzed. TUA, compared with TRA, was associated with a similar risk of major adverse cardiovascular and cerebrovascular events (MACCE) (3.05% vs. 3.32%, OR 0.9, 95% CI [0.65, 1.25]; P = 0.53), access cross-over rate (9.4% vs. 4.1%, OR 1.92, 95% CI [0.91, 4.06]; P = 0.09), access-site complications (12.7% vs. 13%, OR 0.97, 95% CI [0.79, 1.19]; P = 0.75), vasospasm (8.1% vs. 9%, OR 0.83, 95% CI [0.54, 1.27]; P = 0.38), procedural time (MD 1.34 min, 95% CI [-1.31, 3.99]; P = 0.32) and fluoroscopy time (MD 0.29 min, 95% CI [-0.33, 0.91]; P = 0.36). Additional analysis of patients who underwent PCI showed no difference in the incidence of MACCE, access-site complications and large hematoma. The risk of local bleeding was lower in the TUA group compared with TRA (4.9% vs. 8.5%, OR 0.55, 95% CI [0.33, 0.93]; P = 0.02).

Conclusion: TUA is a safe approach in both CA and PCI with comparable outcomes to TRA. PCI with TUA might be associated with a lower risk of local bleeding compared with TRA.