Comprehensive CT Assessment of Subclavian Artery Tortuosity: Implications for Optimal Radial Access Selection

Abstract

Background: Right radial artery access is the most commonly used approach for coronary angiography. Tortuosity of the right subclavian artery (RSA) may complicate catheter navigation. Whether the left subclavian artery (LSA) provides a less tortuous alternative remains uncertain.

Objectives: The purpose of this study was to compare the tortuosity between the RSA and LSA, identify clinical predictors of subclavian tortuosity, and assess its impact on coronary angiography fluoroscopy time.

Methods: We analyzed 695 consecutive patients from the CALCI-TAVI cohort who underwent contrast-enhanced computed tomography and coronary angiography as part of their preaortic valve replacement work-up. Subclavian tortuosity was measured by a tortuosity index, corresponding to the centerline-to-straight-line distance ratio computed from three-dimensional reconstruction data. Multivariable logistic regression identified clinical predictors of increased tortuosity. The impact of high tortuosity on fluoroscopy time was also evaluated.

Results: RSA showed significantly greater tortuosity than LSA on average (51.8 [38.6-70.4] vs 40.00 [28.30-54.39], P < 0.001) and its tortuosity exceeded that of LSA in two-third of the population. Independent predictors of high RSA tortuosity included age ≥80 years, female gender, prior stroke, and thoracic kyphosis (P < 0.05 for all). Patients in the high tortuosity group had significantly longer fluoroscopy times 5 (3-9) vs 3 (2-5) minutes (P = 0.001).

Conclusions: RSA tortuosity is significantly more frequent and pronounced than LSA tortuosity and is associated with age ≥80 years, female sex, prior stroke, and thoracic kyphosis. Elevated tortuosity contributes to longer coronary angiography procedures. These findings contribute to identify clinical profiles that may derive greater benefit from a left radial access during coronary angiography.

Keywords: coronary angiography; subclavian artery; vascular tortuosity.