Jaffe R
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Transradial Learning Curve
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Jaffe R
- 1. Trans-‐radial Learning Curve Ronen Jaffe MD, Cardiology Department, Carmel Medical Center, Haifa, Israel
- 3. Why is the transradial approach more challenging? • Small artery • Vasospasm • Thrombosis • Anatomic varia;on • Subop;mal training • Equipment designed for femoral approach • Right radial approach-‐more challenging
- 4. 3 2 1
- 5. Mechanism and predictors of failed TR approach for PCI Dehghani JACC Intv 2009;2:1057– 64 • 2,100 patients underwent TR-PCI (38% of PCI volume) • Vascular complications: 22 (1%) • TR-PCI failure: 98 (4.7%) • PCI was successful in 94 (96%) patients with TR-PCI failure by switching to TF
- 6. Mechanism of failed TR PCI % • Spasm, • Subclavian tortuosity, • Dissection, • Inadequate guide • Loop, backup support • Stenosis Dehghani JACC Intv 2009;2:1057– 64
- 8. Conclusions • Challenging TR pa;ents 3 can be iden;fied pre-‐ procedure: – Short 2 – Elderly 1 – S/P CABG
- 9. Different learning curves for right vs. LeA radial angiography Sciahbasi AJC 2011;108:185–188 • 532 coronary angiograms • 6 fellows • Randomized to right or left radial approach • 3 stages in learning curve: Ø 0-100 cases Ø 101-200 cases Ø >200 cases
- 10. Fluoroscopy time (sec) Radial artery cannulation time ≤ 3 min • Stage 1: <40 % of cases • Stage 3: >60 % of cases
- 11. Conclusions • A learning curve exists for both radial access & transradial coronary angiography • The right radial approach is more challenging (vs. leA radial)
- 12. Characterization of Operator Learning Curve for Transradial (TR) PCI Ball Circ Cardiovasc Interv. 2011;4:336-341 • 1672 patients undergoing single-vessel TR-PCI • 28 operators • Case volume: Ø 1-50, Ø 51-100, Ø 101-150, Ø 151-300 • TR-PCI failure occurred in 4%
- 13. Odds of failure was reduced by 32% for each 50 increments in case volume Ball Circ Cardiovasc Interv. 2011;4:336-341
- 15. Tips
- 17. Work comfortably
- 18. • Don’t fear failure: Can almost always convert to femoral access • Access the radial artery gently-‐1 shot, anterior puncture • Use dedicated access device. eg. Cook system • Fluoroscopy during wire advance • Use angio if difficulty in advancing wire • Use hydrophilic wire • Medica;on: Verapamil-‐5 mg, Heparin • Choice of sheath??? • For angio/PCI: Use regular femoral equipment with different sizes
- 19. Thank you