The radial artery (RA) is recommended as the vascular access of choice in patients undergoing coronary angiography and intervention. The procedural and clinical performance of dual- versus single-catheter strategy in patients undergoing transradial coronary angiography remains a matter of debate.

Methods

This is a study-level meta-analysis of randomized trials. The primary outcome was procedure time. The main secondary outcome was fluoroscopy time. Other outcomes of interest were contrast volume, crossover to other catheter strategy and RA spasm.

Results

A total of 2,062 patients (978 randomly assigned to dual-catheter and 1,084 to single-catheter strategy) included in seven trials were available for the quantitative synthesis. A dual-catheter strategy was associated with procedure time (standardized mean difference [95% confidence intervals (CI)], 0.55 [−0.69, 1.78]; p = .32), fluoroscopy time (−0.36 [−2.39, 1.67]; p = .68) and contrast volume (−0.93 [−3.79, 1.94]; p = .44) comparable to a single-catheter strategy. The risk for crossover was lower (risk ratio [95% CI], 0.14 [0.03, 0.70]; p = .025) while the risk for RA spasm was higher (1.81 [1.54, 2.12]; p < .001) among patients assigned to dual- versus single-catheter strategy.

Conclusions

This meta-analysis provides evidence for a comparable procedural performance of either dual- or single-catheter strategy for transradial coronary angiography. The fewer crossovers with dual-catheter strategy occur at the expense of more frequent radial artery spasm.

CONFLICT OF INTEREST

The authors declare no potential conflict of interest.

Supporting Information

Filename	Description
ccd28458-sup-0001-FigS1.tiffTIFF image, 2.3 MB	Figure S1 PRISMA flow chart for the trial selection process. PRISMA, preferred reporting items for systematic reviews and meta-analyses
ccd28458-sup-0002-FigS2.zipapplication/x-zip-compressed, 168.1 KB	Figure S2 Forest plots for secondary outcomes with dual- versus single-catheter strategy for transradial coronary angiography. Standardized mean difference for contrast volume (Panel A) and risk ratio for crossover (Panel B) and radial artery spasm (Panel C) with dual- versus single-catheter strategy for transradial coronary angiography. The diamonds indicate the point estimate and the left and the right ends of the lines the 95% confidence intervals.
ccd28458-sup-0003-FigS3.zipapplication/x-zip-compressed, 60.7 KB	Figure S3 Contour enhanced funnel plot for primary and main secondary outcomes with dual- versus single-catheter strategy for transradial coronary angiography. Contours are plotted for a range of significance levels defined by p-values of .01, .05, and .1. The publication bias for procedure (Panel A) and fluoroscopy time (Panel B) is evaluated by visual inspection and by a linear regression test of funnel ploy asymmetry (p = .67 and .15, respectively).
ccd28458-sup-0004-FigS4.zipapplication/x-zip-compressed, 94.3 KB	Figure S4 Influence analysis for primary and main secondary outcomes with dual- versus single-catheter strategy for transradial coronary angiography. Random-effects estimates for procedure (Panel A) and fluoroscopy time (Panel B) are computed omitting one study at time.
ccd28458-sup-0005-Tables.docxWord 2007 document , 40.7 KB	Table S1 PRISMA checklist. Table S2. Main characteristics and definitions of outcomes according to protocols across trials included in the study. Table S3. Assessment of risk of bias of trials included in the study. Table S4. Subgroup analysis for all outcomes.

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Volume96, Issue2

August 2020

Pages 276-282

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Procedural and clinical performance of dual- versus single-catheter strategy for transradial coronary angiography: A meta-analysis of randomized trials

Abstract

Objectives

Background

Methods

Results

Conclusions

CONFLICT OF INTEREST

Supporting Information

REFERENCES

Citing Literature

References

Information

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Procedural and clinical performance of dual- versus single-catheter strategy for transradial coronary angiography: A meta-analysis of randomized trials

Abstract

Objectives

Background

Methods

Results

Conclusions

CONFLICT OF INTEREST

Supporting Information

REFERENCES

Citing Literature

References

Related

Information