**9. Conclusion**

have shown a reduction in fluoroscopy time and number of catheters used in LRA compared to RRA, while Freixa et al. [31] and the "transradial approach (left vs. right) and procedural times during percutaneous coronary procedures (TALENT) study" demonstrated similar procedure and fluoroscopy time between both approaches when performed by well‐trained operators [30]. Moreover, decreased radiation exposure with LRA was detected by Kado et al. [32] which is not concordant with the results of sub‐study of the "TALENT" trial, which dem‐ onstrated no differences in radiation dose between the two approaches [33]. Recently, several studies have shown that the LRA might be associated with shorter procedural time and lower cerebrovascular complications when compared with the RRA in elective PCI [29, 34, 35].

Data from published studies addressing the best transradial approach (TRA) (right vs. left) in the setting of primary PCI are scarce, while data in the setting of elective PCI are controversial. Although the right radial artery (RRA) approach is usually the first point of access, tortuosity within the brachial and subclavian arteries may result in more radiation exposure, lengthy procedure, or even procedural failure [34, 36, 37]. Alternatively, the left radial artery (LRA) approach, although unflavored and less extensively studied, may offer an advantage from the

Since delay in the reperfusion, time is considered the main cause of mortality in STEMI patients [38, 39], it is essential to decrease the reperfusion time when undergoing primary PCI. As the choice of transradial access site over the femoral approach is preferred in patients with STEMI because of less bleeding complications, it remains undetermined whether RRA or LRA pro‐ vides a shorter procedural time in STEMI patients undergoing primary PCI. Up to date, only a few researches have compared the access side (right vs. left) during primary PCI [40–42].

We did a retrospective study on 400 consecutive patients presenting to our hospital with STEMI. Primary PCIs were performed for 202 patients using the right radial approach and 198 using the left radial approach. Results show that there was no significant difference in demo‐ graphics and clinical characteristics for patients included in both groups with mean age 57 ± 12.8 years, with male predominance (77.2%). There was no significant difference between the right radial and left radial regarding success rate (97.5 for RRA vs. 98.4% for LRA; *P* = 0.77), contrast amount used (151.2 ± 12.4 ml for the RRA vs. 150.8 ± 19.6 ml for the LRA; *P* = 0.41), fluoroscopy time (FT) (13.2 ± 4.3 min for the RRA vs. 12.8 ± 3.5 min for the LRA), needle‐to‐ balloon time (18.2 ± 2.8 min vs. 17.8 ± 6.5 min for RRA & LRA respectively, *P* = 0.12), number of catheters, postprocedure vascular complications, in‐hospital reinfarction, and stroke/tran‐ sient ischemic attack (TIA) or death. We concluded that both right radial access and left radial access are safe and effective in primary PCI, as both approaches have a high success rate and

A recent retrospective study done on 135 patients compared LRA vs. RRA in STEMI patients. Primary PCIs were performed for 85 patients using the right radial approach and 50 using the left radial approach. Results show that there was no significant difference in room procedural

**8. Right vs. left radial access in acute myocardial infarction**

point‐of‐view of vascular anatomy [29, 33].

10 Interventional Cardiology

comparable needle‐to‐balloon time [40].

The choice of TRA access site (right vs. left) in primary PCI depends on the experience of performing operator and demographics of treated population. With well‐trained operators in both approaches, no significant difference in safety or effectiveness of either approach can be detected, as demonstrated in our study and by the "TALENT" study (senior group) in elective PCI and Larsen et al. in primary PCI [30, 41]. On the other hand, LRA shows better outcomes (compared to RRA) with less trained operators or those trained mainly on LRA, as demonstrated by the results of "TALENT" study (the fellow group) and by Fu et al. [30, 42].

Populations characterized by short stature or low BMI (e.g., Chinese population in Fu et al.) [42] showed better outcomes with LRA in primary PCI. On the other hand, Saito et al. [44] revealed lower success rates via LRA in Japanese patients, which were due to a higher reported frequency of left subclavian arteries originating too distally and/or tortuosity not permitting catheter advancement to the aortic root.

Similarity between RRA and LRA in safety and effectiveness gives more space for TRA in primary PCI, as more patients can achieve rapid and successful revascularization (similar to TFA) but with the added safety margin that TRA provides.
