Transradial interventions -local perspective

Transradial interventionsTransradial interventions-local perspective-local perspective

Dr Syed Nadeem Hassan Dr Syed Nadeem Hassan Rizvi,Rizvi,

MBBS (Pb), Dip Card (lon) , MRCP(UK), FSCAIMBBS (Pb), Dip Card (lon) , MRCP(UK), FSCAI

As. Professor of Cardiology, As. Professor of Cardiology,

National institute of Cardiovascular National institute of Cardiovascular diseases,diseases,

KarachiKarachi

Why Transradial ?Why Transradial ?

Early (immediate?) Early (immediate?) ambulationambulation

Less local complications Less local complications than transfemoralthan transfemoral

Less ‘labour / staff ’ Less ‘labour / staff ’ intensiveintensive

Downside of transradialDownside of transradial

Steep learning curveSteep learning curve Limited availability of specific Limited availability of specific

radial catheters at present radial catheters at present Access limited upto 7F in most Access limited upto 7F in most

patients , which therefore, patients , which therefore, excludes certain techniques e.g excludes certain techniques e.g simultaneous stenting and IABP simultaneous stenting and IABP insertion insertion

TRI-PreparationTRI-Preparation

TRI-PreparationTRI-Preparation

TRI-PreparationTRI-Preparation

TRI-PreparationTRI-Preparation

TRI-Final table setupTRI-Final table setup

TRI- Local anaestheticTRI- Local anaesthetic

TRI- AccessTRI- Access

TRI- AccessTRI- Access

TRI- AccessTRI- Access

TRI - AccessTRI - Access

TRI- Sheath removalTRI- Sheath removal

TRI- Access closure / TR TRI- Access closure / TR bandband

TRI- Access closure / TR TRI- Access closure / TR bandband

TRI – TR band closureTRI – TR band closure

TRI- Immediate TRI- Immediate ambulationambulation

TRI- MaterialTRI- Material

Radistop

Radstat Stepty P

Easy Radial

Gauze and tape/ bandage

TRI- Diagnostic TRI- Diagnostic catheterscatheters

TRI- Guiding cathetersTRI- Guiding catheters

Guide cathetersGuide catheters

Radial curve (BSS)

Muta wiseguide (BSS)

Fadajet (Cordis)

Kimney Runway (BSS)

Mann IMA (BSS)

Radial / brachial Radial / brachial anatomyanatomy

JR for LCAJR for LCA

TRI- Primary PCITRI- Primary PCI

TRI- Primary PCITRI- Primary PCI

TRI- Primary PCITRI- Primary PCI

TRI – Kissing balloon (6F TRI – Kissing balloon (6F access)access)

TRI- bifurcation PCITRI- bifurcation PCI

TRI – bifurcation PCITRI – bifurcation PCI

TRI – Complex rescue TRI – Complex rescue PCIPCI

TRI – Complex rescue TRI – Complex rescue PCIPCI

Femoral fluro timesNICVD JAN'07-FEB'08

av=9.7min -7 values>20min av= 7.5min

0

20

40

60

80

1 5 9 13 17 21 25 29 33 37 41 45 49 53 57 61 65 69 73 77 81 85 89

patient

tim

e(m

in)

Radial fluro times NICVD JAN'07-FEB'08

av= 14min -7 values >20min av=9.6min

0

10

20

30

40

50

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43

patient

tim

e(m

in)

Conclusion IConclusion I

TRI is a safe and effective TRI is a safe and effective procedureprocedure

Has a steep learning curve and Has a steep learning curve and therefore needs persistence and therefore needs persistence and dedication to master techniquededication to master technique

Variety of specific hardware is Variety of specific hardware is limited in Pakistan mainly due to limited in Pakistan mainly due to low volumeslow volumes

Conclusion IIConclusion II

Fluro times are marginally longer Fluro times are marginally longer than femoral procedures but usually than femoral procedures but usually decline with increasing expertise decline with increasing expertise

No specific subgroup should be No specific subgroup should be exempted from this technique except exempted from this technique except those where >7F diameter access is those where >7F diameter access is necessarynecessary

Teaching institutes should try and Teaching institutes should try and adopt this technique as ‘first line’ due adopt this technique as ‘first line’ due to its safety and cost effectivenessto its safety and cost effectiveness

Thank YouThank You