Right versus left radial approach in percutaneous coronary interventions: a comparative study of access efficiency and procedural outcomes

Abstract Objective The radial artery approach is a Class I recommendation for coronary procedures in the ESC guidelines. However, there are no specific guidelines favoring either the right or left radial approach. Consequently, the choice of access remains at the discretion of the interventional cardiologist. Despite its potential advantages, the left radial approach is still underutilized by many operators. Methods This one-year prospective non-randomized study included 100 patients undergoing percutaneous coronary procedures. Patients were divided into two groups; 52 underwent the right radial approach (RRA), and 48 underwent the left radial approach (LRA). The primary aim was to compare both approaches’ feasibility and potential procedural complications. Results The LRA group demonstrated significantly lower rates of radial artery spasm (8.3% vs. 44.2%, p < 0.001), radial artery tortuosity (2.1% vs. 23.1%, p = 0.002), and subclavian artery tortuosity (14.6% vs. 32.7%, p = 0.034) compared to the RRA group. Median radiation exposure time was significantly shorter in the LRA group (129.0 [87.75–246.5] seconds) compared to the RRA group (254.0 [161.0–469.5] seconds), p < 0.001. Patient comfort was significantly higher with the LRA (100% vs. 75%, p < 0.001). Among patients aged ≥ 65 years, LRA was associated with lower rates of spasm, tortuosity, and radiation exposure time. Conclusion The left radial approach is a feasible and safe access route for percutaneous coronary interventions, offering notable advantages over the right radial approach, including reduced arterial spasm, lower tortuosity, shorter radiation exposure, and better patient comfort. Elderly patients particularly benefit from left radial access.