Transradial

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  • Transradial access to percuatanous coronary intervention shows significant advantages over the femoral approach when used by experienced clinicians.

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    A growing body of evidence suggests that a transradial intervention rather than a transfemoral approach to PCI is associated with greater reductions in bleeding complications than those achieved with pharmacological strategies alone.

    Whilst the transfemoral approach to cardiac catheterization has dominated the huge growth of invasive cardiology to date, transradial access appeared early in the development of cardiac catheterization techniques as early as 1948.

    Despite early enthusiasm for the approach, equipment limitations resulted in a shift to larger vessels for most catheter-based procedures, and the radial artery was consigned as a site for monitoring arterial pressure.

    In the late 1970s, percutaneous coronary angioplasty was introduced using predominantly 9-F guiding catheters. Building on reports of successful transradial angiography from Canada in 1989, four years later, Kiemeneij and Laarman first reported on the transradial approach for coronary stenting.

    Given observed reductions in periprocedural bleeding and reported improvements in patient comfort, a few enthusiastic early adopters surfaced, although transradial intervention generally remained a niche technique. The greater technical complexity of the procedure compared to the transfemoral procedure and the associated significant learning curve hindered its uptake.

    As experience with transradial intervention grew, the lack of severe access-site complications when compared with the transfemoral approach to coronary angiography and coronary intervention was repeatedly demonstrated in small observational studies.

    Cost-effectiveness was also demonstrated and small single-centre or limited multicenter randomised comparisons to femoral and brachial approaches showed the superiority of transradial intervention with respect to vascular access site complications, patient preference and speed of post-procedural recovery.

    There are important veins or nerves near to the radial artery in the wrist, which decreases the likelihood of arteriovenous fistulas or nerve lesions; the superficial trajectory of the artery and its proximity to the bone allow simple hemostasis by means of simple compression, bypassing the need for closure devices and decreasing the chance of hematoma and pseudoaneurysm.

    Several studies have reported that the patients can ambulate almost immediately following the procedure, which increases the patient´s comfort and level of satisfaction, and at the same time decreases the length of hospital stay and the cost.

    Nevertheless, the procedure could only be performed with safety in patients with a normal Allen test, and technically, the procedure is more complex than the transfemoral procedure due to the greater difficulty in cannulating the artery, variations in the arteries of the upper limb, possibility of spasm, and the manipulation of the catheters that is necessary to cannulate the coronary arteries.

    These difficulties result in a slight increase in the length of time needed for the procedure and time needed for fluoroscopy. There is also a significant learning curve involved, even for specialists with a a lot of experience in transfemoral procedures.

    However, ESC Guidelines published last year give the highly recommend the radial approach over the femoral one for coronary angiography and percutaneous coronary intervention (PCI) in patients with acute coronary syndromes (ACS). The ACS without persistent ST-segment elevation (NSTE-ACS) guidelines are published online on the ESC Website and in European Heart Journal.

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Transradial Intervention

Transradial artery access (TRA) for diagnostic CA or percutaneous coronary intervention (PCI) is associated with lower bleeding and vascular complications than transfemoral artery access (TFA). The European Society of Cardiology guidelines and American Heart Association support TRA first strategy and evidence also supports, an improvement in healthcare quality, and reduced cost. While TFA predominates peripheral interventions, increases in dedicated equipment and the technical expertise may result in it as a preferred access in this patient group as well.

The Radcliffe Transradial Intervention educational programme is supported by:

Boehringer Ingelheim

Section editor

Professor James Nolan

University Hospital North Staffordshire, Stoke-on-Trent, UK

Guidelines

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Clinical Trials

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Real World/ Registry

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Case Studies

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Techniques

Risks

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Review

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Radial Artery Occlusion

Health Economics

19th UHNM Transradial Masterclass

19th UHNM Transradial Masterclass

Transradial Masterclass 2019

Welcome and introduction

19th UHNM Transradial Masterclass

The nineteenth iteration of this industry-leading event has held on 15-16 October 2019 at Cottons Hotel, Cheshire, UK.

Under the direction of course organisers Professor Jim Nolan and Dr David Wells, and managed by Millbrook Medical Conferences Ltd, the event again succeeded in providing authorative and compelling update on advances, challenges and best practice in the innovative international PCI field.

Chaired and presented by a faculty of international standing, key sessions from the 2019 event included radial access in interventional radiology, distal radial access, latest developments in TRA, management of TRA complications, analysis of the latest technical innovations, and a review of the latest literature.

To register interest in attending the 2020 two-day event, please visit Millbrook Medical Conferences.

James Nolan
Professor James Nolan is a Consultant Cardiologist and Professor of Interventional Cardiology, as well as a member of the British Coronary Intervention Society and British Cardiovascular Society. He has particular interest in transradial cardiac procedures and percutaneous coronary intervention. &nb

 


Programme Outline
  • Transradial Masterclass 2019
    Welcome and introduction

    James Nolan
  • Session 1: Hot Topics in TRA
    Arterial access site utilisation in European cardiology practice

  • Session 1: Hot Topics in TRA
    Optimal radiation protection for the TRA operator

    Alessandro Sciahbasi
  • Session 2: Femoral Access in 2019 - How to Get it Right
    TFA in (predominant) radial centre

    Azfar Zaman
  • Session 2: Femoral Access in 2019 - How to Get it Right
    How to do a perfect TFA case - what is the data?

    Karim Ratib
  • Session 3: Radial Access in Interventional Radiology
    Transradial fibroid embolisation

    Fatemeh Sakhinia
  • Session 3: Radial Access in Interventional Radiology
    TR prostate artery embolisation

    Mark Little
  • Session 3: Radial Access in Interventional Radiology
    Radial artery access for neurovascular procedures

    Zafar Hashim
  • Session 3: Radial Access in Interventional Radiology
    TR chemoembolisation of liver

    Clare Bent
  • Session 3: Radial Access in Interventional Radiology
    TR weird and wonderful case presentations

    David Wells
  • Session 4: Distal Radial Access
    IdTRA history applied anatomy

    Ferdinand Kiemeneij
  • Session 4: Distal Radial Access
    How to do distal cases - puncture techniques and haemostasis

    Stefan Harb
  • Session 4: Distal Radial Access
    Clinical applications

    Avtandil M. Babunashvili
  • Session 5: Hot Topics in TRA 2
    Insights into the hand circulation

    Cara Hendry
  • Session 5: Hot Topics in TRA 2
    State of the art haemostats in 2019

    Andrew SP Sharp
  • Session 6: What is New in the TRA Literature
    Update from the Keele CV Research Group

    Mamas A Mamas
  • Session 6: What is New in the TRA Literature
    Highlights from the literature

    Helen Routledge
  • Session 7: Technical Innovations
    Transaxillary access

    Rajiv Gulati
  • Session 7: Technical Innovations
    Mechanism of mortality reduction with transradial

    Phillip Freeman
  • Session 8: Angio Review - TRA Complications and their Management
    Case presentation

    Sen Devadathan
  • Session 8: Angio Review - TRA Complications and their Management
    Case presentation 2

    Matthew Li Kam Wa
  • Session 9: How to Set Up an IR Radial Programme
    How TR can improve established services

    Kader Allouni
  • Session 9: How to Set Up an IR Radial Programme
    Pushing the frontiers

    Kader Allouni
The on-demand presentations of the 19th UHNM Transradial Masterclass is supported by :

Session 1: Hot Topics in TRA

Arterial access site utilisation in European cardiology practice

Registry/Cohort Studies

Meta-analyses

Techniques

Case Studies

Radiation Exposure Risk

Specific Risks

Transradial Randomised Clinical Trials (RCT)

Transradial Real-World Outcome Studies

Transradial Cost Analysis

Transradial Radial Artery Occlusion (RAO)

Transradial Courses - Past/On-Demand

Transradial Upcoming Courses

Transradial Health Economics

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