Radial Approach:     An International Journey !      Olivier F. Bertrand, MD, PhD      Associate-Professor of Medicine, La...
Disclosures                    Research grants: Cordis, Eli-Lilly, Bristol-                    Myers-Squibb,GE Healthcare,...
The PastFriday, October 21, 2011
Friday, October 21, 2011
COURTESY OF B FAURIE ANDJ MONSEGU, MD (PARIS, 2010)                                                              ADAPTED F...
PATIENT QUALITY OF LIFE                           SF-36 ONE WEEK POST-CATH (N=200)                                        ...
PATIENT QUALITY OF LIFE                                                     >                                     SCIAHBAS...
NURSING WORKLOAD                                AMOROSO G ET AL. EUR J CARDIOVASC NURS 2005;4:234-41Friday, October 21, 2011
MDs Quality of LifeFriday, October 21, 2011
N = 1107       75 countries       01-08-2010                           BERTRAND OF ET AL. JACC INTV 2010;3:1022-31Friday, ...
CAPUTO R ET AL. CCI 2011 (IN PRESS)Friday, October 21, 2011
Quebec Heart-Lung Institute                                                                                    91-93% RADI...
QHLI- RADIAL VS FEMORAL APPROACHES PER OPERATOR                                             Radial (%)                  Fe...
“Radialist” Feeling After                            Radial Access Failure...Friday, October 21, 2011
TRA NOT A RELIGION!                                       BERTRAND OF ET AL. JACC INTV 2010;3:1022-31Friday, October 21, 2...
Published (Radial)              160                                                                                       ...
Meta-Analysis           Ischemic outcomes: All-cause death and the           combined incidence of Death-MI           Blee...
Studies Selection                                         TOTAL OF 761,919                                            PATI...
Impact on Bleeding                                                            RANDOMIZED                            OR 0.2...
Impact on Transfusion                                                            RANDOMIZED                            OR ...
Impact on Death (Early)                                                           RANDOMIZED                           OR ...
EHJ 2005Friday, October 21, 2011
JACC 2009Friday, October 21, 2011
JACC 2011:...PRESENT BUT NO RECOMMENDATIONFriday, October 21, 2011
EHJ-SEP 2011                           STILL NO RECOMMENDATION !!Friday, October 21, 2011
CCI 2011 (IN PRESS, NOVEMBER ISSUE)Friday, October 21, 2011
Friday, October 21, 2011
RADIATION AND EXPERIENCE                              NEILL J. ET AL. AM J CARDIOL 2010;106:936-40Friday, October 21, 2011
JACOB S ET AL. BMC PUBLIC HEALTH, 2010;10:537Friday, October 21, 2011
NO LEADED GLASSES      CATHPAX  NO LEAD APRON                                                      DOSIMETER = OUTPUT     ...
S RAO, 2011Friday, October 21, 2011
EASY-Bivalirudin To Reduce Bleeding (B2B)                   Patients at high risk of non-access site bleeding ie ≥        ...
Friday, October 21, 2011
Friday, October 21, 2011
FUNDING FOR RADIAL TRIALS RESEARCH ??Friday, October 21, 2011
TRA PRACTICE IN THE FUTURE ?                           50%                                                    BERTRAND OF ...
Supporting the adoption of transradial access                            theradialist.org redesigned                      ...
Supporting the adoption of transradial access                                       FacebookFriday, October 21, 2011
Conclusion: Think Different!                  Transradial practice is already used worldwide                  Use will lik...
IT IS NOT ABOUT YOU!!                            IT IS ABOUT THE PATIENT AND                                 BETTER OUTCOM...
EHJ 2010...STILL NO RECOMMENDATION !!Friday, October 21, 2011
Friday, October 21, 2011
ANTITHROMBOTIC REGIMENS AND RESIDUAL BLEEDING RISK                                                 HAMON ET AL. EUROINTERV...
0                                                                                               1                         ...
0                                      2                                          4                                       ...
Objectives              To conduct a systematic review and              meta-analysis of all observational              st...
PI: S. RAO, M. KRUCOFFFriday, October 21, 2011
JOLLY S ET AL. LANCET 2011, 377:1409-20Friday, October 21, 2011
JOLLY S ET AL. LANCET 2011, 377:1409-20Friday, October 21, 2011
JOLLY S ET AL. LANCET 2011, 377:1409-20Friday, October 21, 2011
JOLLY S ET AL. LANCET 2011, 377:1409-20Friday, October 21, 2011
JOLLY S ET AL. LANCET 2011, 377:1409-20Friday, October 21, 2011
JOLLY S ET AL. LANCET 2011, 377:1409-20Friday, October 21, 2011
Friday, October 21, 2011
Friday, October 21, 2011
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Radial Approach: An International Journey

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  1. 1. Radial Approach: An International Journey ! Olivier F. Bertrand, MD, PhD Associate-Professor of Medicine, Laval University Adjunct-Professor, Department of Mechanical Engineering, McGill University Quebec Heart-Lung Institute DUKE TRANSRADIAL ADVANCED COURSE, 20 OCTOBER 2011Friday, October 21, 2011
  2. 2. Disclosures Research grants: Cordis, Eli-Lilly, Bristol- Myers-Squibb,GE Healthcare, Sanofi- Aventis, Eurocor Consultant: Cordis, Astra-Zeneca, Opsens Research-Scholar from Quebec Foundation for Health ResearchFriday, October 21, 2011
  3. 3. The PastFriday, October 21, 2011
  4. 4. Friday, October 21, 2011
  5. 5. COURTESY OF B FAURIE ANDJ MONSEGU, MD (PARIS, 2010) ADAPTED FROM S RAO, 2011Friday, October 21, 2011
  6. 6. PATIENT QUALITY OF LIFE SF-36 ONE WEEK POST-CATH (N=200) COOPER C ET AL. AM HEART J 1999;138:430-6Friday, October 21, 2011
  7. 7. PATIENT QUALITY OF LIFE > SCIAHBASI A ET AL. INT J CARDIOL 2009;137:199-205Friday, October 21, 2011
  8. 8. NURSING WORKLOAD AMOROSO G ET AL. EUR J CARDIOVASC NURS 2005;4:234-41Friday, October 21, 2011
  9. 9. MDs Quality of LifeFriday, October 21, 2011
  10. 10. N = 1107 75 countries 01-08-2010 BERTRAND OF ET AL. JACC INTV 2010;3:1022-31Friday, October 21, 2011
  11. 11. CAPUTO R ET AL. CCI 2011 (IN PRESS)Friday, October 21, 2011
  12. 12. Quebec Heart-Lung Institute 91-93% RADIAL FOR ANGIO AND PCI 1ST PTCA ALL PCI OPERATORS ALL OPERATORS ALL OPERATORS 7 FR 6 FR 6 FR 5-6 FR FEMORAL KIT 19G NEEDLE ADHOC PCI SAME-DAY DISCHARGE GB ADAPTED FROM TIZON-MARCOS H. ET AL. (2009)Friday, October 21, 2011
  13. 13. QHLI- RADIAL VS FEMORAL APPROACHES PER OPERATOR Radial (%) Femoral (%) 100 16 14 12 10 9 8 8 7 7 6 5 2 98 94 95 92 92 93 93 90 91 88 86 84 75 50 VARIATION IN RADIAL USE IN STEMI 25 AMONG 12 OPERATORS 0 JR SR BN CN EL GP RL LR GB JPD OG OBFriday, October 21, 2011
  14. 14. “Radialist” Feeling After Radial Access Failure...Friday, October 21, 2011
  15. 15. TRA NOT A RELIGION! BERTRAND OF ET AL. JACC INTV 2010;3:1022-31Friday, October 21, 2011
  16. 16. Published (Radial) 160 140 140 120 100 85 Kiemeneij F 80 54 60 51 52 Campeau L 47 49 45 40 29 24 26 15 17 14 20 8 1 0 0 1 1 2 0 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009Friday, October 21, 2011
  17. 17. Meta-Analysis Ischemic outcomes: All-cause death and the combined incidence of Death-MI Bleeding included both standardized and study- specific definitions. Most definitions involved fatal or intracranial bleeding, bleeding associated with Hb drop ≥ 3 g/dl or ≥ 5 g/dl, or access-related bleeding requiring transfusion or surgery Transfusion rates Early (≤ 30 days)Friday, October 21, 2011
  18. 18. Studies Selection TOTAL OF 761,919 PATIENTSFriday, October 21, 2011
  19. 19. Impact on Bleeding RANDOMIZED OR 0.21 (95% CR I: 0.15-0.28) OR 0.27 (95% CR I: 0.08-0.47) OBSERVATIONALFriday, October 21, 2011
  20. 20. Impact on Transfusion RANDOMIZED OR 0.19 (95% CR I: 0.09-0.30) OBSERVATIONAL OR 0.25 (95% CR I: 0.01-1.07)Friday, October 21, 2011
  21. 21. Impact on Death (Early) RANDOMIZED OR 0.52 (95% CR I: 0.40-0.63) OBSERVATIONAL OR 0.80 (95% CR I: 0.49-1.23)Friday, October 21, 2011
  22. 22. EHJ 2005Friday, October 21, 2011
  23. 23. JACC 2009Friday, October 21, 2011
  24. 24. JACC 2011:...PRESENT BUT NO RECOMMENDATIONFriday, October 21, 2011
  25. 25. EHJ-SEP 2011 STILL NO RECOMMENDATION !!Friday, October 21, 2011
  26. 26. CCI 2011 (IN PRESS, NOVEMBER ISSUE)Friday, October 21, 2011
  27. 27. Friday, October 21, 2011
  28. 28. RADIATION AND EXPERIENCE NEILL J. ET AL. AM J CARDIOL 2010;106:936-40Friday, October 21, 2011
  29. 29. JACOB S ET AL. BMC PUBLIC HEALTH, 2010;10:537Friday, October 21, 2011
  30. 30. NO LEADED GLASSES CATHPAX NO LEAD APRON DOSIMETER = OUTPUT FACTOR 10 << << << << RADPAD << COURTESY J ARSENAULT, 2011Friday, October 21, 2011
  31. 31. S RAO, 2011Friday, October 21, 2011
  32. 32. EASY-Bivalirudin To Reduce Bleeding (B2B) Patients at high risk of non-access site bleeding ie ≥ 2 risk-factors: Age > 70, female, CKD, recent GI or organ bleeding, anemia, diabetes, prior GPI/Tnk. ≃ 2500 Transradial PCI HEPARIN BIVALIRUDIN 1ST END-POINT: DEATH, MI, URGENT REVASCULARIZATION, BARC BLEEDING 2,3,5 AT 30 DAYS FUFriday, October 21, 2011
  33. 33. Friday, October 21, 2011
  34. 34. Friday, October 21, 2011
  35. 35. FUNDING FOR RADIAL TRIALS RESEARCH ??Friday, October 21, 2011
  36. 36. TRA PRACTICE IN THE FUTURE ? 50% BERTRAND OF ET AL. JACC INTV 2010;3:1022-31Friday, October 21, 2011
  37. 37. Supporting the adoption of transradial access theradialist.org redesigned 50% RADIAL IN 5 YEARSFriday, October 21, 2011
  38. 38. Supporting the adoption of transradial access FacebookFriday, October 21, 2011
  39. 39. Conclusion: Think Different! Transradial practice is already used worldwide Use will likely continue to increase significantly over next few years Physicians = Education, EBM (Publications !!) Health systems = Cost reduction Patients = Qol, better outcomes Still ways for improvement (RAO...)Friday, October 21, 2011
  40. 40. IT IS NOT ABOUT YOU!! IT IS ABOUT THE PATIENT AND BETTER OUTCOMES... “Great invention and I’d love to invest, but I can’t spend time to learn how to use it and I never have trouble getting places when I have to anyway. I’ll just stick with what I’m doing…” ADAPTED FROM I GILCHRISTFriday, October 21, 2011
  41. 41. EHJ 2010...STILL NO RECOMMENDATION !!Friday, October 21, 2011
  42. 42. Friday, October 21, 2011
  43. 43. ANTITHROMBOTIC REGIMENS AND RESIDUAL BLEEDING RISK HAMON ET AL. EUROINTERVENTION, 2009Friday, October 21, 2011
  44. 44. 0 1 2 0 20 40 60 80 100 120 140 160Friday, October 21, 2011 1989 1 1989 1990 0 1990 1991 0 1991 1992 1 1992 1993 1 1993 1994 2 1994 1995 8 1995 1996 1996 1997 15 1997 1998 24 1998 1999 14 2000 1999 17 2001 2000 47 Randomized Trials (Radial vs Femoral) 2002 2001 26 2003 2002 29 2004 2003 49 2005 2004 54 2006 2005 2007 45 2006 2008 51 2007 2009 52 2010 2008 85 2011 2009 140
  45. 45. 0 2 4 6 8 10 12 14Friday, October 21, 2011 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Observational Studies (Radial vs Femoral) 2004 2005 2006 2007 2008 2009 2010 2011
  46. 46. Objectives To conduct a systematic review and meta-analysis of all observational studies and randomized trials comparing TRA to FA for PCIFriday, October 21, 2011
  47. 47. PI: S. RAO, M. KRUCOFFFriday, October 21, 2011
  48. 48. JOLLY S ET AL. LANCET 2011, 377:1409-20Friday, October 21, 2011
  49. 49. JOLLY S ET AL. LANCET 2011, 377:1409-20Friday, October 21, 2011
  50. 50. JOLLY S ET AL. LANCET 2011, 377:1409-20Friday, October 21, 2011
  51. 51. JOLLY S ET AL. LANCET 2011, 377:1409-20Friday, October 21, 2011
  52. 52. JOLLY S ET AL. LANCET 2011, 377:1409-20Friday, October 21, 2011
  53. 53. JOLLY S ET AL. LANCET 2011, 377:1409-20Friday, October 21, 2011
  54. 54. Friday, October 21, 2011
  55. 55. Friday, October 21, 2011

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