Good News for Radialists in Terms of Radiation Exposure: But Please Do Your Best to Protect Yourselves and Your Patients!

The transradial approach (TRA), mostly right-sided, has been the first choice in our laboratory for about 10 years. We started in 2004 and, in a couple of years, the transition was done.
Not only interventional cardiologists but also, and perhaps more, clinical cardiologists are enthusiastic about TRA, having experienced a striking reduction in bleeding and vascular complication and saving a lot of time for the management of femoral sheaths after the procedure.
Now, in a steady, more “mature” phase, we are collecting more evidence about TRA; after the RIFLE-STEACS trial,(1) we are now involved in the MATRIX trial,(2) and we are also looking in depth into somewhat “neglected” areas of TRA, such as vascular complications (eg, asymptomatic radial artery occlusion) and radiation exposure.
The retrospective analysis performed in our center looks quite reassuring, since we did not observe an increased radiation exposure, as assessed by dose-area product values, in TRA as compared to transfemoral approach. This is in agreement with the most recent findings in the literature, at least in experienced TRA centers.
Nevertheless, there are many unresolved questions that need further investigation, such as operator exposure (we did not measure it in our study nor was it measured in most other studies), the issue of laterality (right vs left-sided TRA), which could impact the radiation dose,(3) and, finally, the issue of additional radiation protective devices.
That’s why we are conducting a substudy of the MATRIX RCT, RAD-MATRIX, in which patients with acute coronary syndrome undergoing coronary procedures will be randomized to either TRA (left vs right) or TFA, with measurement of both patients’ and operators’ radiation exposure. Hopefully, this study will give us firm evidence in this area which, by the way, is very relevant to our health as interventional cardiologists.

Stefano Rigattieri, MD, PhD
Interventional Cardiology
Sandro Pertini Hospital
Rome, ITALY

References
1. Romagnoli E, Biondi-Zoccai G, Sciahbasi A, et al. Radial versus femoral randomized investigation in ST-segment elevation acute coronary syndrome: the RIFLE-STEACS (Radial Versus Femoral Randomized Investigation in ST-Elevation Acute Coronary Syndrome) study. J Am Coll Cardiol. 2012;60:2481-2489.
2. Valgimigli M, Calabrò P, Cortese B, et al; MATRIX Investigators. Scientific foundation and possible implications for practice of the minimizing adverse haemorrhagic events by transradial access site and systemic implementation of AngioX (MATRIX) trial. J Cardiovasc Transl Res. 2014;7:101-111.
3. Sciahbasi A, Romagnoli E, Trani C, et al. Operator radiation exposure during percutaneous coronary procedures through the left or right radial approach: the TALENT dosimetric substudy. Circ Cardiovasc Interv. 2011;4:226-231.

Read the entire article at:
Rigattieri S, Sciahbasi A, Drefahl S, et al. Transradial access and radiation exposure in diagnostic and interventional coronary procedures. J Invasive Cardiol. 2014;26(9):469-474.

View more articles on Radiation Safety at:
Smilowitz NR, Moses JW, Sosa FA, et al. Robotic-enhanced PCI cCompared to the traditional manual approach. J Invasive Cardiol. 2014;26(7):318-321.

Barringhaus KG, Akhter M, Rade JJ, Smith C, Fisher DZ. Operator and institutional experience reduces room-to-balloon times for transradial primary percutaneous coronary intervention. J Invasive Cardiol. 2014;26(2):80-86.

Godino C, Maccagni D, Pavon AG, Viani G, Cappelletti A, Margonato A, Colombo A. Estimating incidence of organ cancer related to PCI radiation exposure in patients treated for acute and chronic total occlusions. J Invasive Cardiol. 2013 Sep;25(9):441-445.

Shah N, Deshmukh A, Sachdeva R. Radiation exposure after percutaneous coronary intervention: is the cancer risk real? J Invasive Cardiol. 2013;25(9):447-448.

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