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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