02 aimradial2016 fri2 EM Vegh
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This study investigated the learning curve for transradial carotid interventions in two high-volume centers between 2010-2016. It found that after performing the first 50-100 cases, procedure duration, fluoroscopy time, and contrast usage decreased significantly. While the success rate remained high at 99.8% and the rate of femoral conversion did not change, complications were low. The study concludes that transradial carotid intervention can be performed safely, with the learning curve to transition taking about 2 years in high-volume centers.
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01 aimradial2016 fri2 Z Ruzsa
01 aimradial2016 fri2 Z RuzsaInternational Chair on Interventional Cardiology and Transradial Approach
Transradial access for femoral artery intervention was evaluated in a pilot study of 98 patients. The study found:
1. Femoral artery angioplasty can be safely performed via transradial access using sheathless guiding catheters, with a technical success rate of 94.9% and major access site complication rate of 3.1%.
2. While complication rates were promising, larger studies are still needed to determine long-term success rates of this transradial approach to femoral interventions.
3. Selecting the left radial access provided advantages like easier access to the descending aorta and use of shorter delivery systems, though the right radial access was used in most cases (77.615 aimradial2016 fri A Amin
15 aimradial2016 fri A AminInternational Chair on Interventional Cardiology and Transradial Approach
Transradial PCI is increasing in the US as it provides value by reducing costs through lower bleeding rates and shorter length of stays. The author's hospital implemented several strategies to increase value, including increased use of transradial PCI, a same-day discharge program, and a patient-centered approach focusing on individualized risk assessment. These strategies led to lower costs, improved outcomes, and increased patient satisfaction while maintaining the ability to treat high-risk patients. The hospital estimates annual savings of over $3 million from these strategies along with improved revenue from quality programs.04 aimradial2016 fri2 A Roy / Y Louvard
04 aimradial2016 fri2 A Roy / Y LouvardInternational Chair on Interventional Cardiology and Transradial Approach
- The study compared safety and technical outcomes of radial versus femoral artery access for endovascular interventions of peripheral arterial lesions.
- 184 patients underwent interventions via radial (65 patients) or femoral (123 patients) access. Radial access failed in 16.9% of cases due to tortuosity or complex lesions.
- There were no differences in major complications between the two groups. Radial access was associated with higher contrast use but no difference in radiation exposure or length of stay.
- Left radial access was associated with less radiation than right radial access. No single predictor of radial access failure was identified.
- The study concluded that radial access for peripheral interventions is safe and feasible for treating a range of lesionGilchrist IC 201305
Ultrasound can help with planning and obtaining radial artery access for cardiovascular procedures. Planning ultrasound examines artery size and anatomy to select the optimal access site and sheath size, reducing fluoroscopy time. Ultrasound guided access improves first stick success rates and reduces average access time compared to palpation or blind access techniques. Meta-analyses show ultrasound guidance significantly increases the chance of successful first attempt radial artery access. While radial angiography provides information if access fails, ultrasound is preferable for access planning and guidance due to reduced pain, contrast, and radiation compared to angiography.
Applegate RJ - AIMRADIAL 2014 - Learning curve
Applegate RJ - AIMRADIAL 2014 - Learning curveInternational Chair on Interventional Cardiology and Transradial Approach
This document discusses the radial approach learning curve for cardiac catheterization procedures. It reviews several studies that attempted to quantify the learning curve. The studies found that procedural metrics like fluoroscopy time decreased with increased operator experience, with most operators showing improvement after 25-40 cases. While a learning curve exists, it may not be as steep as once believed. The document concludes that the learning curve is a reality, but the myth is that it is prohibitively steep.10 Babunashvili aimradial20170921 Snuff box access
10 Babunashvili aimradial20170921 Snuff box accessInternational Chair on Interventional Cardiology and Transradial Approach
This document describes a novel "snuff-box technique" for transradial catheterization using a distal puncture of the radial artery. The author hypothesizes that distal puncture may reduce rates of radial artery occlusion (RAO) and bleeding complications compared to traditional puncture sites. Data from 637 patients found lower RAO rates and complication risks with distal versus traditional access. A future randomized trial is proposed to further evaluate distal access versus traditional sites.Pancholy S - AIMRADIAL 2013 - Radiation exposure
Pancholy S - AIMRADIAL 2013 - Radiation exposureInternational Chair on Interventional Cardiology and Transradial Approach
This document summarizes a systematic review and meta-analysis comparing radiation exposure between transradial and transfemoral access for cardiac catheterization. The analysis included 68 studies with over 666,000 patients. It found that while transradial access was initially associated with slightly higher fluoroscopy times and dose-area products, the difference has decreased over time as operator experience has increased, and recent studies show less than a 1 minute difference between approaches. Transradial access may also reduce operator radiation exposure.Posham R - AIMRADIAL 2014 Endovascular - Chemoembolization
Posham R - AIMRADIAL 2014 Endovascular - ChemoembolizationInternational Chair on Interventional Cardiology and Transradial Approach
Transradial approach facilitates same-day discharge for transarterial chemoembolization to treat hepatocellular carcinomaRecommended
01 aimradial2016 fri2 Z Ruzsa
01 aimradial2016 fri2 Z RuzsaInternational Chair on Interventional Cardiology and Transradial Approach
Transradial access for femoral artery intervention was evaluated in a pilot study of 98 patients. The study found:
1. Femoral artery angioplasty can be safely performed via transradial access using sheathless guiding catheters, with a technical success rate of 94.9% and major access site complication rate of 3.1%.
2. While complication rates were promising, larger studies are still needed to determine long-term success rates of this transradial approach to femoral interventions.
3. Selecting the left radial access provided advantages like easier access to the descending aorta and use of shorter delivery systems, though the right radial access was used in most cases (77.615 aimradial2016 fri A Amin
15 aimradial2016 fri A AminInternational Chair on Interventional Cardiology and Transradial Approach
Transradial PCI is increasing in the US as it provides value by reducing costs through lower bleeding rates and shorter length of stays. The author's hospital implemented several strategies to increase value, including increased use of transradial PCI, a same-day discharge program, and a patient-centered approach focusing on individualized risk assessment. These strategies led to lower costs, improved outcomes, and increased patient satisfaction while maintaining the ability to treat high-risk patients. The hospital estimates annual savings of over $3 million from these strategies along with improved revenue from quality programs.04 aimradial2016 fri2 A Roy / Y Louvard
04 aimradial2016 fri2 A Roy / Y LouvardInternational Chair on Interventional Cardiology and Transradial Approach
- The study compared safety and technical outcomes of radial versus femoral artery access for endovascular interventions of peripheral arterial lesions.
- 184 patients underwent interventions via radial (65 patients) or femoral (123 patients) access. Radial access failed in 16.9% of cases due to tortuosity or complex lesions.
- There were no differences in major complications between the two groups. Radial access was associated with higher contrast use but no difference in radiation exposure or length of stay.
- Left radial access was associated with less radiation than right radial access. No single predictor of radial access failure was identified.
- The study concluded that radial access for peripheral interventions is safe and feasible for treating a range of lesionGilchrist IC 201305
Ultrasound can help with planning and obtaining radial artery access for cardiovascular procedures. Planning ultrasound examines artery size and anatomy to select the optimal access site and sheath size, reducing fluoroscopy time. Ultrasound guided access improves first stick success rates and reduces average access time compared to palpation or blind access techniques. Meta-analyses show ultrasound guidance significantly increases the chance of successful first attempt radial artery access. While radial angiography provides information if access fails, ultrasound is preferable for access planning and guidance due to reduced pain, contrast, and radiation compared to angiography.
Applegate RJ - AIMRADIAL 2014 - Learning curve
Applegate RJ - AIMRADIAL 2014 - Learning curveInternational Chair on Interventional Cardiology and Transradial Approach
This document discusses the radial approach learning curve for cardiac catheterization procedures. It reviews several studies that attempted to quantify the learning curve. The studies found that procedural metrics like fluoroscopy time decreased with increased operator experience, with most operators showing improvement after 25-40 cases. While a learning curve exists, it may not be as steep as once believed. The document concludes that the learning curve is a reality, but the myth is that it is prohibitively steep.10 Babunashvili aimradial20170921 Snuff box access
10 Babunashvili aimradial20170921 Snuff box accessInternational Chair on Interventional Cardiology and Transradial Approach
This document describes a novel "snuff-box technique" for transradial catheterization using a distal puncture of the radial artery. The author hypothesizes that distal puncture may reduce rates of radial artery occlusion (RAO) and bleeding complications compared to traditional puncture sites. Data from 637 patients found lower RAO rates and complication risks with distal versus traditional access. A future randomized trial is proposed to further evaluate distal access versus traditional sites.Pancholy S - AIMRADIAL 2013 - Radiation exposure
Pancholy S - AIMRADIAL 2013 - Radiation exposureInternational Chair on Interventional Cardiology and Transradial Approach
This document summarizes a systematic review and meta-analysis comparing radiation exposure between transradial and transfemoral access for cardiac catheterization. The analysis included 68 studies with over 666,000 patients. It found that while transradial access was initially associated with slightly higher fluoroscopy times and dose-area products, the difference has decreased over time as operator experience has increased, and recent studies show less than a 1 minute difference between approaches. Transradial access may also reduce operator radiation exposure.Posham R - AIMRADIAL 2014 Endovascular - Chemoembolization
Posham R - AIMRADIAL 2014 Endovascular - ChemoembolizationInternational Chair on Interventional Cardiology and Transradial Approach
Transradial approach facilitates same-day discharge for transarterial chemoembolization to treat hepatocellular carcinomaSciahbasi A - AIMRADIAL 2013 - Radiation exposure
Sciahbasi A - AIMRADIAL 2013 - Radiation exposureInternational Chair on Interventional Cardiology and Transradial Approach
Vascular access route (radial vs femoral) and radiation exposure in percutaneous coronary interventions and diagnostic angiographyWimmer N - AIMRADIAL 2014 - Door-to-balloon
Wimmer N - AIMRADIAL 2014 - Door-to-balloonInternational Chair on Interventional Cardiology and Transradial Approach
This document discusses radial PCI and door-to-balloon time for STEMI patients. It notes that while radial PCI is associated with less bleeding and faster recovery, it can also lead to longer procedure times. The document summarizes several studies that have looked at the mortality benefits of radial PCI for STEMI. A key study found that even with an 83 minute delay in door-to-balloon time, radial PCI was still associated with lower mortality based on results from randomized controlled trials. The conclusion is that the benefits of radial PCI outweigh the risks associated with potential delays, and radial PCI should be the preferred approach.Biederman DM - AIMRADIAL 2014 Endovascular - Surefire catheter
Biederman DM - AIMRADIAL 2014 Endovascular - Surefire catheterInternational Chair on Interventional Cardiology and Transradial Approach
This document discusses a study evaluating the feasibility and technical outcomes of using the Surefire Infusion System to deliver chemotherapy or radiation via a transradial (wrist) approach. The study found that the Surefire Catheter can be safely deployed through the wrist to treat liver tumors in 15 patients. Using a transradial approach with the Surefire System offers advantages over traditional techniques like fewer vascular complications and immediate patient ambulation. Pre-procedural imaging can help guide whether this approach is suitable.Mamas M - AIMRADIAL 2014 - Cardiogenic shock
Mamas M - AIMRADIAL 2014 - Cardiogenic shockInternational Chair on Interventional Cardiology and Transradial Approach
Cardiogenic shock is a leading cause of death in AMI patients, with mortality rates between 30-60%. While radial access has been shown to reduce bleeding complications, patients presenting with cardiogenic shock are often treated via transfemoral access. Recent studies have demonstrated that radial access PCI is feasible in cardiogenic shock patients, with one study showing a reduction in in-hospital mortality for radial versus transfemoral access. However, experienced radial centers only use the radial approach in around 50% of cardiogenic shock cases, indicating radial access is still underutilized despite potential benefits in this high-risk group.Bernat I - AIMRADIAL 2014 Technical - Radial artery occlusion
Bernat I - AIMRADIAL 2014 Technical - Radial artery occlusionInternational Chair on Interventional Cardiology and Transradial Approach
This document discusses treatments for radial artery occlusion (RAO) following transradial catheterization. It describes pharmacological treatments including low molecular weight heparin and anticoagulation as well as non-pharmacological options such as ulnar artery compression, percutaneous interventions, and surgery. Ulnar artery compression is highlighted as a simple, safe, and effective method for treating RAO. A new combined approach using balloon angioplasty and localized intra-arterial abciximab is also discussed but requires further validation. Overall, the best approach is prevention of RAO by ensuring patent hemostasis and using slender techniques.Dzavik V - AIMRADIAL 2014 - Rotablator and radial approach
Dzavik V - AIMRADIAL 2014 - Rotablator and radial approachInternational Chair on Interventional Cardiology and Transradial Approach
Rotational atherectomy can be performed via the radial or femoral artery approaches with similar success rates. A study compared outcomes of 67 patients who underwent rotational atherectomy via the femoral approach to 52 patients who underwent it via the radial approach and found no significant differences in procedural characteristics, success rates, or in-hospital complications between the two groups except that pacing wires were inserted less often in the radial group. Overall, rotational atherectomy performed via the radial approach was found to be a feasible alternative to the femoral approach.Mars C - AIMRADIAL 2015 - Allergic reactions SACRED study
Mars C - AIMRADIAL 2015 - Allergic reactions SACRED studyInternational Chair on Interventional Cardiology and Transradial Approach
An evaluation of allergic reactions following radial access. SACRED: Systematic Assessment of the Cook®
Radial shEath DeviceRoberts J - AIMRADIAL 2015 - Ultrasound guidance
Roberts J - AIMRADIAL 2015 - Ultrasound guidanceInternational Chair on Interventional Cardiology and Transradial Approach
1) The study evaluated 565 patients undergoing cardiac catheterization or percutaneous coronary intervention to compare the diameters of the radial and ulnar arteries using intraprocedural ultrasound.
2) The radial artery was found to be larger in 37.1% of patients, while the ulnar artery was larger in 6.5% of patients. A dual radial artery was present in 4.4% of patients.
3) In some cases where the radial artery diameter was very small (<2mm), the ulnar artery was significantly larger and may be a better access site. Evaluating both arteries ultrasonographically can help determine the best access site.Benamer H
The document discusses several studies on vascular complications in overweight patients undergoing percutaneous coronary interventions (PCI) and coronary angiography. The TROP study analyzed outcomes in 346 overweight patients undergoing PCI or angiography. It found the radial approach reduced complications compared to femoral. Other studies also found lower risks with radial access, especially in obese patients. Overall, obesity is a risk factor for cardiovascular disease and complications, and the radial approach may help reduce risks in overweight and obese patients undergoing coronary procedures.
E-poster13 Rusza aimradial20170922 Hybrid approach
E-poster13 Rusza aimradial20170922 Hybrid approachInternational Chair on Interventional Cardiology and Transradial Approach
Zoltan Ruzsa presents results from a pilot study evaluating transradial access for femoral artery interventions. The study included 141 patients with symptomatic femoral artery stenosis treated via transradial access using 6F sheathless guiding catheters between 2014-2016. Angiographic and technical success rates were high at 87.2% and 75.9% respectively, with minor access site complications in only 3 patients (2.1%). While long term follow up showed revascularization was needed in 23.4% of patients at 12 months, the results demonstrate transradial access for femoral interventions can be performed safely with acceptable morbidity. Larger comparative studies are still needed to determine long term outcomes compared to traditional femoral access.Valgimigli M 2015 MATRIX trial transradial
Valgimigli M 2015 MATRIX trial transradialInternational Chair on Interventional Cardiology and Transradial Approach
Results from the minimizing adverse haemorrhagic events by transradial access site and systemic implementation
of angiox-MATRIX - Access Program
Guzman L - AIMRADIAL 2014 - Radiation exposure
Guzman L - AIMRADIAL 2014 - Radiation exposureInternational Chair on Interventional Cardiology and Transradial Approach
Operator radiation exposure and physical discomfort during a right versus left radial approach for coronary interventionsBiederman D - AIMRADIAL 2015 - Radial access in hepatic dysfunction
Biederman D - AIMRADIAL 2015 - Radial access in hepatic dysfunctionInternational Chair on Interventional Cardiology and Transradial Approach
This document summarizes a study examining the use of transradial access (TRA) for non-coronary interventions in patients with severe hepatic dysfunction (MELD score ≥ 20). The study found TRA to be feasible in this high-risk population with a 100% technical success rate and very low rates of bleeding (0%) and access site (1 minor hematoma) complications. TRA in patients with liver dysfunction was shown to be safe and effective for renal/visceral interventions like embolization and stenting as well as radioembolization procedures, with few coagulation blood products required.Patel TM 201111
This document discusses tips and tricks for successful transradial primary PCI. It begins with an introduction and disclosure from the author. It then reviews several studies that found high rates of success (90-100%) and normalization of coronary blood flow with transradial PCI for AMI. No major vascular complications occurred in these studies. Additional studies showed similar success rates and procedural times for transradial PCI compared to transfemoral, with lower rates of major vascular complications. Bleeding complications were associated with increased mortality. The experience of over 880 AMIs at one center using a transradial approach found no major vascular complications. While transradial PCI can present challenges in complex cases, it allows intervention even if thrombolysis was used
Hamon M_2 201111
Radial versus Femoral Access Approaches in Percutaneous Coronary Intervention of Patients Receiving Bivalirudin
Cohen MG - Transradial access - 201507
Cohen MG - Transradial access - 201507International Chair on Interventional Cardiology and Transradial Approach
This document discusses techniques for transradial access and intervention. It begins by outlining three levels of competency for operators and discusses when radial access may not be appropriate. It then provides a step-by-step guide for radial access procedures, covering patient positioning, arterial puncture, navigating vascular anatomy, catheter selection, and hemostasis. Predictors of procedural failure are presented. The document concludes by providing tips for implementing a successful radial program.Van Leeuwen M - AIMRADIAL 2015 - Upper limb function
Van Leeuwen M - AIMRADIAL 2015 - Upper limb functionInternational Chair on Interventional Cardiology and Transradial Approach
1) The ACRA study evaluated the effects of transradial access (TRA) on upper limb function and found that upper limb function, as measured by the QuickDASH score, was unaffected after TRA. A clinical relevant decrease in upper limb function occurred in only 6.3% of patients.
2) Rates of persisting extremity problems were equally reported in patients who received TRA or transfemoral access.
3) Cold intolerance, as measured by the CISS questionnaire, was also unaffected after TRA procedures.
4) While the study found no effects of TRA on upper limb function or cold intolerance, limitations included a potential for response bias and lack of power to detect effects in specific patient groups.17 aimradial2016 fri S Goel
17 aimradial2016 fri S GoelInternational Chair on Interventional Cardiology and Transradial Approach
This study compared the performance of standard Judkins catheters versus the Tiger radial artery specific catheter in 110 patients undergoing coronary angiography via the radial artery approach. The primary findings were that the Tiger catheter resulted in significantly shorter fluoroscopy time but higher failure rates requiring exchange for Judkins catheters. Secondary outcomes of dose area product, contrast volume and procedure time were also lower but not significantly for the Tiger catheter. The safety profiles were similar for both catheters.Bernat I 201111
This document summarizes a randomized trial comparing radial versus femoral approaches for primary PCI in STEMI patients. The trial aims to enroll 700 STEMI patients across 4 centers. The primary endpoints are major bleeding and access site complications within 30 days. Secondary endpoints include mortality, reinfarction, procedural success, and length of stay. The trial is investigator-initiated and supported by grants, with the goal of showing radial access reduces bleeding complications compared to femoral.
Nolan J - AIMRADIAL 2014 - Radialists and femoral access
Nolan J - AIMRADIAL 2014 - Radialists and femoral accessInternational Chair on Interventional Cardiology and Transradial Approach
- A study of 1352 PCI procedures at a radial center found that while 25.2% used femoral access, these cases had fewer complications (12.5% hematomas vs 6.25% requiring intervention) than expected given reduced femoral experience.
- Analysis of UK PCI data found radial use increased from 12-49% for PPCI, with no increase in femoral complications at radial centers and a possible reduction in 30-day mortality for femoral cases at radial centers.
- While radial access is safer, some patients still require femoral, and data suggests radial operators have good outcomes for these cases as well.05 aimradial2016 fri2 Z Ruzsa
05 aimradial2016 fri2 Z RuzsaInternational Chair on Interventional Cardiology and Transradial Approach
This document summarizes a study on gastric artery embolization via radial artery access for the treatment of obesity. The study included 7 obese patients with BMI over 40 and obesity-related conditions. Through selective cannulation and embolization of gastric arteries using PVA particles, the procedure achieved 100% technical success. At 1 month, patients lost an average of 5.6 pounds. No major complications occurred. While more data is needed, gastric artery embolization shows promise as a minimally invasive treatment for obesity.09 aimradial2016 thu2 F Ikeno
09 aimradial2016 thu2 F IkenoInternational Chair on Interventional Cardiology and Transradial Approach
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Wimmer N - AIMRADIAL 2014 - Door-to-balloonInternational Chair on Interventional Cardiology and Transradial Approach
This document discusses radial PCI and door-to-balloon time for STEMI patients. It notes that while radial PCI is associated with less bleeding and faster recovery, it can also lead to longer procedure times. The document summarizes several studies that have looked at the mortality benefits of radial PCI for STEMI. A key study found that even with an 83 minute delay in door-to-balloon time, radial PCI was still associated with lower mortality based on results from randomized controlled trials. The conclusion is that the benefits of radial PCI outweigh the risks associated with potential delays, and radial PCI should be the preferred approach.Biederman DM - AIMRADIAL 2014 Endovascular - Surefire catheter
Biederman DM - AIMRADIAL 2014 Endovascular - Surefire catheterInternational Chair on Interventional Cardiology and Transradial Approach
This document discusses a study evaluating the feasibility and technical outcomes of using the Surefire Infusion System to deliver chemotherapy or radiation via a transradial (wrist) approach. The study found that the Surefire Catheter can be safely deployed through the wrist to treat liver tumors in 15 patients. Using a transradial approach with the Surefire System offers advantages over traditional techniques like fewer vascular complications and immediate patient ambulation. Pre-procedural imaging can help guide whether this approach is suitable.Mamas M - AIMRADIAL 2014 - Cardiogenic shock
Mamas M - AIMRADIAL 2014 - Cardiogenic shockInternational Chair on Interventional Cardiology and Transradial Approach
Cardiogenic shock is a leading cause of death in AMI patients, with mortality rates between 30-60%. While radial access has been shown to reduce bleeding complications, patients presenting with cardiogenic shock are often treated via transfemoral access. Recent studies have demonstrated that radial access PCI is feasible in cardiogenic shock patients, with one study showing a reduction in in-hospital mortality for radial versus transfemoral access. However, experienced radial centers only use the radial approach in around 50% of cardiogenic shock cases, indicating radial access is still underutilized despite potential benefits in this high-risk group.Bernat I - AIMRADIAL 2014 Technical - Radial artery occlusion
Bernat I - AIMRADIAL 2014 Technical - Radial artery occlusionInternational Chair on Interventional Cardiology and Transradial Approach
This document discusses treatments for radial artery occlusion (RAO) following transradial catheterization. It describes pharmacological treatments including low molecular weight heparin and anticoagulation as well as non-pharmacological options such as ulnar artery compression, percutaneous interventions, and surgery. Ulnar artery compression is highlighted as a simple, safe, and effective method for treating RAO. A new combined approach using balloon angioplasty and localized intra-arterial abciximab is also discussed but requires further validation. Overall, the best approach is prevention of RAO by ensuring patent hemostasis and using slender techniques.Dzavik V - AIMRADIAL 2014 - Rotablator and radial approach
Dzavik V - AIMRADIAL 2014 - Rotablator and radial approachInternational Chair on Interventional Cardiology and Transradial Approach
Rotational atherectomy can be performed via the radial or femoral artery approaches with similar success rates. A study compared outcomes of 67 patients who underwent rotational atherectomy via the femoral approach to 52 patients who underwent it via the radial approach and found no significant differences in procedural characteristics, success rates, or in-hospital complications between the two groups except that pacing wires were inserted less often in the radial group. Overall, rotational atherectomy performed via the radial approach was found to be a feasible alternative to the femoral approach.Mars C - AIMRADIAL 2015 - Allergic reactions SACRED study
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An evaluation of allergic reactions following radial access. SACRED: Systematic Assessment of the Cook®
Radial shEath DeviceRoberts J - AIMRADIAL 2015 - Ultrasound guidance
Roberts J - AIMRADIAL 2015 - Ultrasound guidanceInternational Chair on Interventional Cardiology and Transradial Approach
1) The study evaluated 565 patients undergoing cardiac catheterization or percutaneous coronary intervention to compare the diameters of the radial and ulnar arteries using intraprocedural ultrasound.
2) The radial artery was found to be larger in 37.1% of patients, while the ulnar artery was larger in 6.5% of patients. A dual radial artery was present in 4.4% of patients.
3) In some cases where the radial artery diameter was very small (<2mm), the ulnar artery was significantly larger and may be a better access site. Evaluating both arteries ultrasonographically can help determine the best access site.Benamer H
The document discusses several studies on vascular complications in overweight patients undergoing percutaneous coronary interventions (PCI) and coronary angiography. The TROP study analyzed outcomes in 346 overweight patients undergoing PCI or angiography. It found the radial approach reduced complications compared to femoral. Other studies also found lower risks with radial access, especially in obese patients. Overall, obesity is a risk factor for cardiovascular disease and complications, and the radial approach may help reduce risks in overweight and obese patients undergoing coronary procedures.
E-poster13 Rusza aimradial20170922 Hybrid approach
E-poster13 Rusza aimradial20170922 Hybrid approachInternational Chair on Interventional Cardiology and Transradial Approach
Zoltan Ruzsa presents results from a pilot study evaluating transradial access for femoral artery interventions. The study included 141 patients with symptomatic femoral artery stenosis treated via transradial access using 6F sheathless guiding catheters between 2014-2016. Angiographic and technical success rates were high at 87.2% and 75.9% respectively, with minor access site complications in only 3 patients (2.1%). While long term follow up showed revascularization was needed in 23.4% of patients at 12 months, the results demonstrate transradial access for femoral interventions can be performed safely with acceptable morbidity. Larger comparative studies are still needed to determine long term outcomes compared to traditional femoral access.Valgimigli M 2015 MATRIX trial transradial
Valgimigli M 2015 MATRIX trial transradialInternational Chair on Interventional Cardiology and Transradial Approach
Results from the minimizing adverse haemorrhagic events by transradial access site and systemic implementation
of angiox-MATRIX - Access Program
Guzman L - AIMRADIAL 2014 - Radiation exposure
Guzman L - AIMRADIAL 2014 - Radiation exposureInternational Chair on Interventional Cardiology and Transradial Approach
Operator radiation exposure and physical discomfort during a right versus left radial approach for coronary interventionsBiederman D - AIMRADIAL 2015 - Radial access in hepatic dysfunction
Biederman D - AIMRADIAL 2015 - Radial access in hepatic dysfunctionInternational Chair on Interventional Cardiology and Transradial Approach
This document summarizes a study examining the use of transradial access (TRA) for non-coronary interventions in patients with severe hepatic dysfunction (MELD score ≥ 20). The study found TRA to be feasible in this high-risk population with a 100% technical success rate and very low rates of bleeding (0%) and access site (1 minor hematoma) complications. TRA in patients with liver dysfunction was shown to be safe and effective for renal/visceral interventions like embolization and stenting as well as radioembolization procedures, with few coagulation blood products required.Patel TM 201111
This document discusses tips and tricks for successful transradial primary PCI. It begins with an introduction and disclosure from the author. It then reviews several studies that found high rates of success (90-100%) and normalization of coronary blood flow with transradial PCI for AMI. No major vascular complications occurred in these studies. Additional studies showed similar success rates and procedural times for transradial PCI compared to transfemoral, with lower rates of major vascular complications. Bleeding complications were associated with increased mortality. The experience of over 880 AMIs at one center using a transradial approach found no major vascular complications. While transradial PCI can present challenges in complex cases, it allows intervention even if thrombolysis was used
Hamon M_2 201111
Radial versus Femoral Access Approaches in Percutaneous Coronary Intervention of Patients Receiving Bivalirudin
Cohen MG - Transradial access - 201507
Cohen MG - Transradial access - 201507International Chair on Interventional Cardiology and Transradial Approach
This document discusses techniques for transradial access and intervention. It begins by outlining three levels of competency for operators and discusses when radial access may not be appropriate. It then provides a step-by-step guide for radial access procedures, covering patient positioning, arterial puncture, navigating vascular anatomy, catheter selection, and hemostasis. Predictors of procedural failure are presented. The document concludes by providing tips for implementing a successful radial program.Van Leeuwen M - AIMRADIAL 2015 - Upper limb function
Van Leeuwen M - AIMRADIAL 2015 - Upper limb functionInternational Chair on Interventional Cardiology and Transradial Approach
1) The ACRA study evaluated the effects of transradial access (TRA) on upper limb function and found that upper limb function, as measured by the QuickDASH score, was unaffected after TRA. A clinical relevant decrease in upper limb function occurred in only 6.3% of patients.
2) Rates of persisting extremity problems were equally reported in patients who received TRA or transfemoral access.
3) Cold intolerance, as measured by the CISS questionnaire, was also unaffected after TRA procedures.
4) While the study found no effects of TRA on upper limb function or cold intolerance, limitations included a potential for response bias and lack of power to detect effects in specific patient groups.17 aimradial2016 fri S Goel
17 aimradial2016 fri S GoelInternational Chair on Interventional Cardiology and Transradial Approach
This study compared the performance of standard Judkins catheters versus the Tiger radial artery specific catheter in 110 patients undergoing coronary angiography via the radial artery approach. The primary findings were that the Tiger catheter resulted in significantly shorter fluoroscopy time but higher failure rates requiring exchange for Judkins catheters. Secondary outcomes of dose area product, contrast volume and procedure time were also lower but not significantly for the Tiger catheter. The safety profiles were similar for both catheters.Bernat I 201111
This document summarizes a randomized trial comparing radial versus femoral approaches for primary PCI in STEMI patients. The trial aims to enroll 700 STEMI patients across 4 centers. The primary endpoints are major bleeding and access site complications within 30 days. Secondary endpoints include mortality, reinfarction, procedural success, and length of stay. The trial is investigator-initiated and supported by grants, with the goal of showing radial access reduces bleeding complications compared to femoral.
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- A study of 1352 PCI procedures at a radial center found that while 25.2% used femoral access, these cases had fewer complications (12.5% hematomas vs 6.25% requiring intervention) than expected given reduced femoral experience.
- Analysis of UK PCI data found radial use increased from 12-49% for PPCI, with no increase in femoral complications at radial centers and a possible reduction in 30-day mortality for femoral cases at radial centers.
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05 aimradial2016 fri2 Z Ruzsa
05 aimradial2016 fri2 Z RuzsaInternational Chair on Interventional Cardiology and Transradial Approach
This document summarizes a study on gastric artery embolization via radial artery access for the treatment of obesity. The study included 7 obese patients with BMI over 40 and obesity-related conditions. Through selective cannulation and embolization of gastric arteries using PVA particles, the procedure achieved 100% technical success. At 1 month, patients lost an average of 5.6 pounds. No major complications occurred. While more data is needed, gastric artery embolization shows promise as a minimally invasive treatment for obesity.09 aimradial2016 thu2 F Ikeno
09 aimradial2016 thu2 F IkenoInternational Chair on Interventional Cardiology and Transradial Approach
Biodesign in 2016, US and Japan perspective, F Ikeno04 aimradial2016 thu2 B Zafirovska
04 aimradial2016 thu2 B ZafirovskaInternational Chair on Interventional Cardiology and Transradial Approach
This document discusses the benefits of performing pre-procedural radial artery angiography in STEMI patients undergoing primary percutaneous coronary intervention (PPCI) via the transradial approach. It presents data from a study of over 3,600 STEMI patients who underwent PPCI. Radial artery angiography was able to identify anatomical variations in 8.6% of patients. These variations were associated with higher rates of radial artery spasm, access site bleeding complications, and crossover to alternative access sites. The study concludes that routine radial artery angiography prior to PPCI can help identify variations that may impact the procedure, allowing operators to be better prepared to address challenges and potentially improving outcomes.03 aimradial2016 fri Y Ikari
03 aimradial2016 fri Y IkariInternational Chair on Interventional Cardiology and Transradial Approach
This document describes the use of a 6 French brachial intra-aortic balloon pump (IABP) to provide cardiac support during complex percutaneous coronary interventions (PCI) done via the transradial approach. The author presents data on 15 patients who underwent elective PCI with prophylactic 6F brachial IABP support and had no access site complications, shorter bed rest time, and shorter hospital stay compared to patients who received 8F femoral IABP support. While the 6F brachial IABP allows for cardiac support during complex transradial PCI, its small balloon volume, lack of pressure monitoring, and short catheter length limit its use to certain patients and clinical situations.11 aimradial2016 thu2 SB Pancholy Vasoband
11 aimradial2016 thu2 SB Pancholy VasobandInternational Chair on Interventional Cardiology and Transradial Approach
VasoBand is a device that compresses the ulnar artery to increase blood flow in the radial artery for vascular access procedures. It works by augmenting mean intraluminal pressure in the radial artery through mild ulnar artery compression. The ulnar artery is difficult to compress directly due to its location and proximity to nerves, so VasoBand provides optimal compression of the ulnar artery at Guyon's canal using a proprietary arch design that transmits pressure only to the ulnar artery. It features a seamless compression of both arteries, a larger radial balloon to reduce compressive force, and a comfortable, transparent design to reduce trauma.05 aimradial2016 thu2 M Vidovich
05 aimradial2016 thu2 M VidovichInternational Chair on Interventional Cardiology and Transradial Approach
This document discusses catheter selection and techniques for successful angiography. It begins with introductions and disclosures by Dr. Mladen I. Vidovich. The bulk of the document discusses factors to consider when selecting diagnostic catheters for right and left radial access, including patient characteristics like age, height, weight, and previous CABG. Specific catheter types and brands are described, such as Judkins, Amplatz, and universal/multipurpose catheters. Techniques for dealing with challenges like tortuous arteries and ventriculography are also covered. The goal is to provide guidance on choosing the optimal catheter based on each patient's individual anatomy.04 aimradial2016 fri T Tokarek/Z Siudak
04 aimradial2016 fri T Tokarek/Z SiudakInternational Chair on Interventional Cardiology and Transradial Approach
This study analyzed data from the Polish National Registry (ORPKI) comparing outcomes of radial versus femoral access for percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). After propensity score matching, there were 6,542 pairs of patients. The results showed that radial access was associated with lower periprocedural mortality and significantly reduced bleeding complications at the access site both during hospitalization and after PCI compared to femoral access. However, allergic reactions occurred more frequently with radial access. In conclusion, radial access provided benefits over femoral access in reducing bleeding while being as effective for treating STEMI patients.14 aimradial2016 fri I Jovin
14 aimradial2016 fri I JovinInternational Chair on Interventional Cardiology and Transradial Approach
A meta-analysis of 12 randomized controlled studies with a total of 6450 patients compared outcomes of left versus right radial access for coronary procedures. The analysis found:
1) No significant difference in cross over rates or procedure failure between left and right radial access.
2) Procedure duration and contrast volume were similar, though right radial access had slightly longer fluoroscopy time and more contrast used.
3) Right radial access showed significantly more tortuosity of the right subclavian artery, but no significant difference in vascular or embolic complications.
4) Both left and right radial access are viable alternatives for coronary procedures, though left radial access had some slight advantages. However, the clinical relevance of these findings is13 aimradial2016 thu M Hestbjerg-Poulsen
13 aimradial2016 thu M Hestbjerg-PoulsenInternational Chair on Interventional Cardiology and Transradial Approach
This document summarizes a study evaluating the association between activated clotting time (ACT) levels and time to hemostasis and radial artery patency following radial artery catheterization. The study found that higher ACT levels were weakly correlated with longer times to hemostasis, with a difference of only 10 minutes between low and high ACT groups. ACT levels were not significantly associated with radial artery patency. The conclusions were that ACT levels do not have a clinically significant impact on outcomes and that there is no need to consider protamine sulfate treatment following radial procedures.11 aimradial2016 thu A Babunashvili
11 aimradial2016 thu A BabunashviliInternational Chair on Interventional Cardiology and Transradial Approach
This document describes a novel technique for recanalizing the radial artery after late occlusion. The technique involves puncturing the deep palmar arterial arch as a distal entry point for retrograde recanalization of the radial artery. The technique was attempted in 22 patients with late radial artery occlusion, with a success rate of 90.1%. Only one complication occurred, a perforation of the radial artery. Preliminary results suggest the deep palmar arch provides good access for recanalization when the radial artery forearm segment is totally occluded or the stump is short. However, a learning curve is required to reliably use this new entry point.16 aimradial2016 fri F Yoshimachi
16 aimradial2016 fri F YoshimachiInternational Chair on Interventional Cardiology and Transradial Approach
Virtual 3Fr PCI: the V3 registry, F Yoshimachi14 aimradial2016 thu MG Cohen tricks and tips
14 aimradial2016 thu MG Cohen tricks and tipsInternational Chair on Interventional Cardiology and Transradial Approach
The document discusses the results of a study on the impact of climate change on global wheat production. Researchers found that rising temperatures will significantly reduce wheat yields across different regions of the world by the end of the century. Under a high emissions scenario, wheat production is projected to decrease between 6-27% globally depending on the region, posing substantial risks to global food security.07 aimradial2016 thu RK Gokhroo
07 aimradial2016 thu RK GokhrooInternational Chair on Interventional Cardiology and Transradial Approach
Ulnar artery intervention may be non-inferior to radial approach when performed by an experienced operator. The AJULAR study was a randomized non-inferiority trial comparing ulnar to radial artery access. It found that when the operator had over 50 previous ulnar cannulations, complication rates like MACE, hematoma, spasm and crossover were non-inferior for ulnar compared to radial access. The study suggests that with experience, ulnar access provides an easy, safe and comfortable alternative to radial or femoral access for coronary procedures.03 aimradial2016 fri2 A Patel
03 aimradial2016 fri2 A PatelInternational Chair on Interventional Cardiology and Transradial Approach
This study evaluated the safety and feasibility of using a combined dual access radial and pedal approach for treating chronic total occlusions of the superficial femoral arteries. 86 patients underwent endovascular intervention using a primary pedal access and dual access if the pedal approach failed. For 49 lesions where the pedal approach failed, dual transpedal and transradial access was used. The technical success rate was 98% and procedural success rate was 96%, with no peri-procedural complications. The study demonstrated the dual access approach is a safe and feasible alternative to treat complex superficial femoral artery chronic total occlusions.03 aimradial2016 thu M Mamas
03 aimradial2016 thu M MamasInternational Chair on Interventional Cardiology and Transradial Approach
This study examined whether increased use of radial artery access for PCI procedures in the UK between 2006-2013 was associated with worse outcomes for femoral artery access procedures. The study found:
1) Centers that predominantly used radial access tended to reserve femoral access for higher risk patients, leading to initially worse femoral outcomes.
2) After adjusting for differences in patient risk, femoral outcomes were similar between high and low radial access centers.
3) There is no evidence that increased radial access led to decreased proficiency in femoral access or worse femoral outcomes in the UK, where 75% of PCI procedures now use radial access.Assessment of Intermediate Coronary Artery Lesion with Fractional Flow Reserv...
Fraction flow reserve (FFR) is considered the gold standard for assessing intermediate coronary lesions. Retrospective data analyses showed variable relationship between intravascular ultrasound (IVUS) parameters and FFR results. This study aimed to determine the optimal minimum lumen area (MLA) by IVUS that correlates with FFR and to assess the correlation between two modalities in assessing intermediate coronary lesions. Methods: Fifty eight intermediate coronary lesions mainly located in proximal and mid segments of large main coronary vessels with RVD (3-4mm) were analyzed using both IVUS and FFR to assess the significance of coronary stenting and to determine the optimal IVUS-MLA that correlates with FFR value < 0.8. Results: IVUS-MLA ranged from 2.5 to 4.2 mm2 had a highly significant positive correlation with FFR value < 0.8 (p < 0.0001). Using the ROC curve analysis, IVUS-MLA < 3.9 mm2 (84.2% sensitivity, 80% specificity, area under curve (AUC) = 0.68) was the best threshold value for identifying FFR <0.8>< 0.8 in coronary vessels with RVD (3-4mm). Different MLA cutoffs should be used for different vessel diameters.
01 aimradial2016 fri R Gil
This document discusses the use of intravascular ultrasound (IVUS) guided percutaneous coronary intervention (PCI) of the left main coronary artery. It notes that IVUS can help optimize stent placement, reduce contrast volume by about 20ml, and decrease fluoroscopy time by about 3 minutes compared to procedures not using IVUS. The document presents a case example of IVUS guided PCI of the left main using the BiOSS Lim bifurcation stent. Post-procedure IVUS and OCT showed good stent expansion and apposition with no complications.
05 aimradial2016 fri CS Kwok
05 aimradial2016 fri CS KwokInternational Chair on Interventional Cardiology and Transradial Approach
This document presents a systematic review and meta-analysis examining the risk of adverse neurological events from radial versus femoral artery access for cardiac catheterization. The review found a stroke rate of 0.14% for radial access versus 0.19% for femoral access based on over 500,000 procedures. Specifically, it found no increased risk of ischaemic or haemorrhagic stroke with radial compared to femoral access. The conclusions were that radial access is not associated with an increased risk of stroke events compared to femoral access.07 aimradial2016 fri T Schaeufele
07 aimradial2016 fri T SchaeufeleInternational Chair on Interventional Cardiology and Transradial Approach
This document summarizes a case of successful revascularization of a chronic total occlusion (CTO) in the right coronary artery (RCA) via retrograde approach using an epicardial collateral and a single 6F guide catheter. A 76-year old female presented with stable but recurrent angina despite optimal medical therapy and was found to have a CTO in the RCA on diagnostic angiography. Through a transradial retrograde approach using low profile guidewires and microcatheters, the collateral was probed retrogradely and the wire was externalized antegradely, successfully crossing the CTO. The RCA was then stented. Follow-up angiography and FFR confirmed successful revascularization with improvement10 aimradial2016 fri R Diletti
10 aimradial2016 fri R DilettiInternational Chair on Interventional Cardiology and Transradial Approach
Ultrasound evaluation of radial artery changes after catheterization procedures.
The study used high-resolution ultrasound to image the radial artery puncture site before, immediately after, and 30 days following catheterization procedures in 90 patients. It found: 1) the radial artery lumen size increased initially but then decreased, while wall thickness increased over time; 2) minor wall injuries like dissections were common immediately after but did not predict clinical issues; 3) radial artery occlusion occurred in 3.9% of patients and loss of pulsation in 9.1% with smaller baseline artery size and multiple puncture attempts increasing risk.Viewers also liked (20)
Assessment of Intermediate Coronary Artery Lesion with Fractional Flow Reserv...
Assessment of Intermediate Coronary Artery Lesion with Fractional Flow Reserv...
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Terapi Endovaskuler, Standar Baru Manajemen Stroke Iskemik Akut?
Konon, plenary pertama International Stroke Conference (ISC) 2015 yang digelar di Nashville, Tennessee bulan Februari lalu merupakan sesi ISC terseru selama beberapa tahun terakhir. Sebagaimana diberitakan dalam Medscape (Hughes, 2015), para presenter terpaksa memberi jeda beberapa saat untuk menyambut applause dari audiens. Suatu kejadian langka dalam partemuan saintifik. Adalah MR CLEAN, ESCAPE, EXTEND-IA, dan SWIFT PRIME yang menjadi topik hangat lantaran keempat studi ini dirilis dengan hasil yang positif dramatis hingga diprediksi bakal menjadikan terapi endovascular sebagai standar baru dalam manajemen stroke iskemik akut. Sehebat apakah 4 studi yang “menyejarah” dalam tatalaksana stroke iskemik akut ini? Bagaimana bila studi-studi ini diadopsi dan diaplikasikan dalam praktik sehari-hari di sentra kita?
Note: Esai ini ditulis saat SWIFT PRIME fulltext belum published (akhir Maret-awal April 2015). Update & beberapa revisi dibuat menjelang presentasi tanggal 18 Mei 2015.
IS STENTING TO MAINTAIN VASCULAR PATENCY GOING TO BE THE FUTURE
This document discusses the use of stenting to maintain vascular patency for hemodialysis access and whether it will be the future standard. It notes that while stenting is established for coronary arteries, its role for arteriovenous fistulas (AVFs) and grafts (AVGs) is still controversial. The document reviews several studies that showed no benefit or increased complications from stenting AVFs/AVGs compared to angioplasty alone. However, it also discusses some limited evidence that covered stents or stents placed in specific situations like central venous stenosis may improve patency compared to angioplasty. Overall, the document questions whether stenting will become the standard given the lack of strong evidence, complications risks
Steam catheter
This study assessed the safety and efficacy of steam vein sclerosis (SVS) for treating the great saphenous vein in 75 patients over 12 months. At 6 months, 96% of treated veins were successfully obliterated as assessed by duplex ultrasound. Quality of life scores improved significantly at 6 months for both physical and mental components. SVS achieved obliteration rates similar to other thermal ablation techniques with minimal post-operative pain and no major complications reported.
Ivancev 2
The document discusses fenestrated endovascular aneurysm repair (FEVAR) for juxtarenal abdominal aortic aneurysms. It summarizes studies comparing outcomes of open surgery, FEVAR, and chimney EVAR. FEVAR had lower mortality and complications than open surgery. The Zenith Fenestrated graft and a new preloaded P-Branch device were presented. The P-Branch aims to improve precision and reduce planning/production time but may have limitations from imperfect vessel alignment. Overall, FEVAR improves outcomes over open repair for juxtarenal aneurysms.
Assessment_of_Postoperative_Bleeding_after_Dental.15 (2).pdf
This study assessed postoperative bleeding in 100 patients who underwent dental extractions while continuing their antiplatelet therapy (APT). The patients were on either mono APT (78%) or dual APT (22%). Postoperative bleeding was observed in 16 patients on mono APT at 1 hour, but in no patients at 24-48 hours. For dual APT, bleeding was observed in 10 patients at 1 hour and 1 patient at 24 hours, with no bleeding by 48 hours. Statistical analysis found the bleeding rates were significant. The results suggest that dental extractions can generally be performed safely in patients continuing APT, as postoperative bleeding is minor and can be controlled with local hemostatic measures.
Stich ii trial for supratentorial intra cerebral bleed
This document summarizes the STICH II trial which compared early surgery versus initial conservative treatment for spontaneous supratentorial lobar intracerebral haemorrhages between 10-100mL. The trial involved 601 patients randomized to either early surgery within 12 hours or initial conservative treatment with delayed surgery if needed. The primary outcome of death or severe disability at 6 months showed no significant difference between the groups. Secondary outcomes of mortality, functional scales also showed no significant differences, indicating that early surgery did not improve outcomes over initial conservative treatment for these types of hemorrhages.
ANZUP1 (dragged)
This survey aimed to assess clinicians' use of stereotactic radiotherapy and targeted therapies for metastatic renal cell carcinoma and determine support for future clinical trials. The primary objective was to evaluate the proportion of clinicians using radiotherapy for metastatic renal cell carcinoma. Secondary objectives included evaluating the proportion using targeted therapies and radiotherapy simultaneously, stopping targeted therapies for radiotherapy, and supporting further research. The online survey was distributed to members of urology and oncology groups in Australia and New Zealand to collect data on current practices. Results and conclusions will be presented at an upcoming conference.
Interventional therapies for hypertension
This document discusses various interventional therapies for resistant hypertension and renal artery stenosis, including renal sympathetic nerve ablation (RDN), baroreceptor activation therapy (BAT), and arteriovenous shunt creation. It provides details on techniques such as radiofrequency ablation and ultrasound ablation for RDN. It outlines trial results showing reductions in blood pressure from RDN, BAT, and arteriovenous shunts. It also discusses limitations of renal artery stenting based on recent trials. In summary, the document reviews novel interventional approaches for treating difficult cases of high blood pressure.
Percutaneous Nephrolithotomy
This study evaluated the safety and efficacy of percutaneous nephrolithotomy (PCNL) guided solely by ultrasonography in over 700 cases over 5 years. Access to the pelvicalyceal system was successful in all cases using ultrasonography. The overall stone-free rate was 87.4% and complications were minor, with a low 16% rate. The study demonstrated that PCNL can be performed safely and effectively using only ultrasonography guidance, avoiding the risks of radiation exposure from fluoroscopy.
Erirs vs pcnl uro fair2019 eko indra
ECIRS versus PCNL for renal stone management. A meta-analysis of 3 studies with over 300 patients found that ECIRS had a shorter mean operative time and higher stone-free rate compared to PCNL, but similar length of hospital stay. A randomized controlled trial assessed 67 patients and found ECIRS had a shorter operative time and higher stone-free rate. Risk of bias was low. The analysis concluded ECIRS is more efficacious than PCNL for renal stones.
Consecutive Aneurysms Treated by Endovascular Approach
Endovascular coiling is now the primary treatment approach for ruptured intracranial aneurysms based on evidence from trials like ISAT showing improved outcomes compared to clipping. The presenter's experience with 33 patients with 35 consecutive aneurysms showed high rates of aneurysm occlusion (95%) and good clinical outcomes (87.6% had mRS 0-2) when treated using a protocol-based endovascular approach with neurosurgical and critical care support. Complications were low when meticulous techniques were used along with protocols for management of issues like vasospasm.
Dr. Amy Managh, Loughborough University
This document discusses new technologies for single cell detection and analysis using laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS). It describes a method for labelling T cells with gadolinium for tracking cell-based therapies. A new laser ablation system design is presented that improves speed and sensitivity for single cell analysis by using a small inner chamber and single diameter transport tubing to minimize sample loss. The system enables detection of labelled cells for over 10 days both in vitro and in mouse studies.
Leadless pacemaker
Dr. Kayal discusses leadless pacemakers as an alternative to conventional pacemakers which require surgical implantation of leads and have associated risks of complications. Leadless pacemakers are self-contained devices that are implanted via catheter into the right ventricle, avoiding the need for leads or surgical pockets. Two main types discussed are the Nanostim leadless pacemaker and the Micra transcatheter pacing system. Clinical trials of both devices demonstrated high implantation success rates and low complication rates comparable to conventional pacemakers. Leadless pacemakers were shown to effectively pace the heart with stable function over time.
Vascular Access Part 1: Reducing risk and increasing catheter longevity
Vascular access is essential for critically ill patients in the ICU. Nearly all patients will require some form of vascular device such as a PIVC, PICC, or CVC. While necessary, these devices carry risks of complications and infection if not inserted and managed properly. The document emphasizes that insertion is only a small part of device management, and more attention needs to be paid to the 99% of time the device is in use. It provides recommendations for proper device selection, insertion technique including use of ultrasound and micro-puncture, dressing and securement, and tip location to reduce risks and improve device longevity during the critical care stay.
Prospective, randomized comparison of 2 methods of cold snare polypectomy for...
This study compared two methods of cold snare polypectomy for removing small colorectal polyps: 1) using a dedicated cold snare designed specifically for cold polypectomy, and 2) using a traditional polypectomy snare for cold polypectomy. The study found that using the dedicated cold snare resulted in a significantly higher rate of complete polyp removal compared to the traditional snare, especially for polyps between 8-10mm. Rates of immediate bleeding were similar between the two groups. Histological examination found similar rates of arteries and injured arteries in the submucosa between groups.
Neurointerventional Therapy for Brain Aneurysms and Acute Stroke
By Yasha Kadkhodayan, MD. Overview of interventional neuroradiology approaches to brain aneurysm and stroke care, discussion of processes in place at Abbott Northwestern to enhance the delivery of stroke care.
TransUlnar approach - our experience in nhf . Dr. Ashok Dutta
1) The study compares the transulnar approach (TUA) to coronary angiography and angioplasty with the traditional transradial approach (TRA) in Bangladeshi patients, with the goal of assessing safety, efficacy, and procedural factors of both approaches.
2) Over 12 months, 225 patients underwent TUA while 229 underwent TRA. Successful cannulation was higher with TRA (92.14% vs 81.72% for TUA), but complications were lower for TUA.
3) Procedural times, radiation exposure, and findings during coronary angiography were generally similar between the two groups. Loss of arterial pulse was lower for TUA both during hospitalization and follow-up.
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This document provides details regarding a thesis presentation on comparing outcomes of laparoscopic appendicectomy using single versus double endoloop knots at the base of the appendix. The study aims to evaluate operation duration, post-operative complications, and hospital stay for the two techniques. A literature review found no consensus on whether single or double knots are superior. The study plans to enroll 90 patients undergoing laparoscopic appendicectomy and randomly assign them to single or double knot groups. Patient details, operative findings, and outcomes will be collected and statistically analyzed to compare the techniques.
Standard versus tubeless mini percutaneous nephrolithotomy
This study compared outcomes of standard mini-percutaneous nephrolithotomy (SmPCNL) versus tubeless mini-percutaneous nephrolithotomy (TmPCNL) in patients with renal stones. There were no significant differences in operative time, drop in hemoglobin, postoperative leakage, or stone-free rates between the two groups. However, the TmPCNL group had significantly less postoperative analgesic requirements and shorter hospital stays compared to the SmPCNL group. The results suggest TmPCNL is as effective as SmPCNL at clearing stones but with less pain and shorter recovery time by avoiding nephrostomy tube placement.
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The native small cephalic vein may be overlooked during radiocephalic Arteriovenous Fistula (AVF) creation due to concerns over failure rates particularly if the diameter is small. However, native access has benefits in patency and infection risk in selected patients over alternatives such as arteriovenous graft or tunneled hemodialysis catheter. The aim of this study was to review the outcomes of intraoperative Plain Balloon Angioplasty (PBA) in patients with small cephalic veins during AVF creation. We evaluated the maturation, primary and secondary patency rate of salvaged arteriovenous fistulae and identified risk factors related to patency rate.
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PCI & AimRadial 2018 | Innovation in Cardiovascular Medicine - Tim A. FischellInternational Chair on Interventional Cardiology and Transradial Approach
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PCI & AimRadial 2018 | Right Heart Access by Radial - Ian C GilchristInternational Chair on Interventional Cardiology and Transradial Approach
This document discusses accessing the right heart and central venous system through the radial vein as a safer alternative to traditional femoral access. It provides tips for establishing venous access through the forearm, including using ultrasound or no-touch technology to locate veins and heparin locks to improve efficiency. Challenges like low venous pressure, valves, and junctions are addressed. Images demonstrate techniques for navigating the radial artery into the right atrium, including using flushes of saline. Potential contraindications like arm trauma or breast cancer are noted. The document argues learning both arterial and venous radial techniques will improve cardiologist skills and safety.PCI & AimRadial 2018 | Radial Artery Puncture - Ian C Gilchrist
PCI & AimRadial 2018 | Radial Artery Puncture - Ian C GilchristInternational Chair on Interventional Cardiology and Transradial Approach
This document discusses techniques for radial artery puncture for cardiovascular procedures. It notes that the radial artery is smaller in diameter than the femoral artery. Successful radial access requires correctly positioning and securing the wrist. Ultrasound guidance can help find and access the radial artery, especially for trainees. The initial puncture approach can be anterior wall only or use a counterpuncture technique. Sheath size, length, and coating impact radial artery spasm and occlusion. Cocktails including nitroglycerine and calcium channel blockers are commonly used but acid in the cocktail may damage the artery if felt by the patient.PCI & AimRadial 2018 | Post-PCI FFR: Time is coming - Olivier F. Bertrand
PCI & AimRadial 2018 | Post-PCI FFR: Time is coming - Olivier F. BertrandInternational Chair on Interventional Cardiology and Transradial Approach
This document summarizes a presentation given by Dr. Olivier Bertrand on post-PCI FFR measurement. It discusses studies showing that a post-PCI FFR of 0.90 or higher is associated with lower rates of re-PCI and major adverse cardiac events. It then outlines the proposed PREDICT randomized study to evaluate whether routine post-PCI FFR measurement can guide PCI strategy and completion. The study would measure FFR after successful PCI in all-comers and randomize patients to clinical follow-up alone or with guidance from the post-PCI FFR results. The goal is to establish if physiology-guided PCI optimization can improve outcomes and reduce costs.PCI & AimRadial 2018 | Lessons from iFR-SWEDEHEART and DEFINE-FLAIR - Hitoshi...
PCI & AimRadial 2018 | Lessons from iFR-SWEDEHEART and DEFINE-FLAIR - Hitoshi...International Chair on Interventional Cardiology and Transradial Approach
This document summarizes lessons learned from the DEFINE-FLAIR and iFR-SWEDEHEART clinical trials. The trials found:
1) Decision-making based on instantaneous wave-free ratio (iFR) was non-inferior to fractional flow reserve (FFR) for guiding revascularization and reducing major adverse cardiac events over 1-2 years.
2) iFR-guided decisions resulted in significantly less revascularization procedures compared to FFR.
3) Subgroup analysis found increased event rates among diabetic patients evaluated with FFR compared to iFR.
4) iFR has been upgraded to a Class IA recommendation in European Society of Cardiology guidelines based on these trialsPCI & AimRadial 2018 | Use of physiology in ACS - Colin Berry
PCI & AimRadial 2018 | Use of physiology in ACS - Colin Berry International Chair on Interventional Cardiology and Transradial Approach
1. The document discusses the use of physiology in acute coronary syndrome (ACS) patients, including trials evaluating fractional flow reserve (FFR) and index myocardial resistance (IMR) measurements.
2. Several trials showed that FFR-guided revascularization in multivessel disease STEMI patients reduced major cardiac events compared to culprit-only PCI or medical therapy. Ongoing trials are further evaluating FFR in ACS.
3. IMR predicts mortality and heart failure in STEMI patients and adversely remodeling post-STEMI.
4. Incomplete revascularization is common in ACS and associated with worse outcomes; FFR may help guide more complete revascularization. The clinical utility of physiology in ACSPCI & AimRadial 2018 | FFR using 4Fr catheters: Can Slender Technique Work He...
PCI & AimRadial 2018 | FFR using 4Fr catheters: Can Slender Technique Work He...International Chair on Interventional Cardiology and Transradial Approach
This document discusses the potential use of 4 French (4F) catheters for fractional flow reserve (FFR) measurements as a less invasive alternative to larger catheters. It notes that 4F catheters have a smaller profile but can lack the ability to directly perform percutaneous coronary intervention if needed. The document outlines key considerations for using 4F catheters, including ensuring the catheter lumen is well flushed and the pressure transducer is not damped. It concludes that improvements are still needed, such as reducing friction between the pressure wire and catheter, in order to maximize the benefits of using the smallest catheter size possible.PCI & AimRadial 2018 | FFR in Left Main Disease - William F. Fearon
PCI & AimRadial 2018 | FFR in Left Main Disease - William F. FearonInternational Chair on Interventional Cardiology and Transradial Approach
This document discusses using fractional flow reserve (FFR) to evaluate ambiguous left main coronary artery disease. It presents a case of an 82-year-old woman with chest pain and a recent stent in the circumflex artery. FFR measurements of the left main and left anterior descending artery were 0.64, indicating significance. Intravascular ultrasound also suggested significance. The left main and proximal left anterior descending artery were stented, and post-procedure FFR measurements improved. The document reviews evidence that FFR can safely guide decisions about revascularization of ambiguous left main lesions.PCI & AimRadial 2018 | FFR-CT - Colin Berry
PCI & AimRadial 2018 | FFR-CT - Colin BerryInternational Chair on Interventional Cardiology and Transradial Approach
This document summarizes a presentation on CT-derived fractional flow reserve (FFR-CT). It discusses how FFR-CT increases the positive predictive value of coronary CT angiography (CTCA). Several landmark studies are summarized that evaluated the diagnostic accuracy of FFR-CT compared to CTCA. The PACIFIC trial findings showing high diagnostic accuracy of FFR-CT are described. Ongoing and upcoming clinical trials using FFR-CT like PRECISION and DECISION are mentioned. Novel applications of FFR-CT for biomechanics analysis and PCI planning are presented. Finally, new methods like user-generated CT-FFR that may reduce processing time are introduced, though accuracy needs further evaluation.PCI & AimRadial 2018 | Image based FFR during coronary angiography - Hitoshi...
PCI & AimRadial 2018 | Image based FFR during coronary angiography - Hitoshi...International Chair on Interventional Cardiology and Transradial Approach
This document summarizes the results of a study evaluating the diagnostic accuracy of quantitative flow ratio (QFR) compared to fractional flow reserve (FFR) as the reference standard. The study included 317 lesions in 273 patients. Key results included:
- QFR showed superior sensitivity and specificity for detecting functionally significant lesions compared to 2D quantitative coronary angiography.
- QFR values correlated well with invasive FFR measurements.
- QFR could be computed within a similar time frame as FFR measurements.
- A hybrid approach using QFR and FFR may allow pressure wire-free assessment in 68% of lesions while maintaining high diagnostic accuracy.More from International Chair on Interventional Cardiology and Transradial Approach (20)
PCI & AimRadial 2018 | Innovation in Cardiovascular Medicine - Tim A. Fischell
PCI & AimRadial 2018 | Innovation in Cardiovascular Medicine - Tim A. Fischell
PCI & AimRadial 2018 | A novel stent concept for South America - Ramses Galaz
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PCI & AimRadial 2018 | Biomechanics of biodegradable stents: a primer for car...
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PCI & AimRadial 2018 | Radial vs Femoral: Review of the Evidence in 2018 - Ia...
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PCI & AimRadial 2018 | Best practices in same day discharge - Ivo Bernat
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PCI & AimRadial 2018 | Even the big boss fail - Zoltán Ruzsa
PCI & AimRadial 2018 | Even the big boss fail - Zoltán Ruzsa
PCI & AimRadial 2018 | Contemporary Transradial Access Practices: Results of ...
PCI & AimRadial 2018 | Contemporary Transradial Access Practices: Results of ...
PCI & AimRadial 2018 | A Growing Population in the Cath Lab: Patient Identifi...
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PCI & AimRadial 2018 | Treating Cardiogenic Shock with Impella with Escalatio...
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PCI & AimRadial 2018 | LEFT MAIN PCI Lessons from the BCIS registry - Jim Nolan
PCI & AimRadial 2018 | LEFT MAIN PCI Lessons from the BCIS registry - Jim Nolan
PCI & AimRadial 2018 | Left Ventricular Endomyocardial Biopsy by Transradial...
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PCI & AimRadial 2018 | Right Heart Access by Radial - Ian C Gilchrist
PCI & AimRadial 2018 | Right Heart Access by Radial - Ian C Gilchrist
PCI & AimRadial 2018 | Radial Artery Puncture - Ian C Gilchrist
PCI & AimRadial 2018 | Radial Artery Puncture - Ian C Gilchrist
PCI & AimRadial 2018 | Post-PCI FFR: Time is coming - Olivier F. Bertrand
PCI & AimRadial 2018 | Post-PCI FFR: Time is coming - Olivier F. Bertrand
PCI & AimRadial 2018 | Lessons from iFR-SWEDEHEART and DEFINE-FLAIR - Hitoshi...
PCI & AimRadial 2018 | Lessons from iFR-SWEDEHEART and DEFINE-FLAIR - Hitoshi...
PCI & AimRadial 2018 | Use of physiology in ACS - Colin Berry
PCI & AimRadial 2018 | Use of physiology in ACS - Colin Berry
PCI & AimRadial 2018 | FFR using 4Fr catheters: Can Slender Technique Work He...
PCI & AimRadial 2018 | FFR using 4Fr catheters: Can Slender Technique Work He...
PCI & AimRadial 2018 | FFR in Left Main Disease - William F. Fearon
PCI & AimRadial 2018 | FFR in Left Main Disease - William F. Fearon
PCI & AimRadial 2018 | Image based FFR during coronary angiography - Hitoshi...
PCI & AimRadial 2018 | Image based FFR during coronary angiography - Hitoshi...
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02 aimradial2016 fri2 EM Vegh
- 1. Eszter. M. Végh, B. Nemes, B. Teleki, B. Merkely, K. Huttl, Z. Ruzsa Learning curve of the transradial approach of percutaneous carotid intervention
- 2. • The authors have nothing to disclose. 2
- 3. Introduction • Stenting of internal carotid artery is a current treatment option of patients with high risk of stroke. Transradial approach became a novel alternative of conventional, transfemoral intervention, as a • Safe and • Effective treatment option. Ruzsa Z. et al: A randomised comparison of transradial and transfemoral approach for carotid artery stenting: RADCAR (RADial access for CARotid artery stenting) study. EuroIntervention 2014 – Higher radiation dose was experienced at transradial, then at transfemoral access.
- 4. Our aim • Investigation of the transradial carotid intervention learning curve in two high-volume centers. 4 Bács-Kiskun Megyei Kórház, Kecskemét, Hungary Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- 5. Methods - Patients In two centers, between 2010-2016/1: 1664 patients underwent carotid stenting. Indication was: • ≥ 70% stenosis, neurological symptoms, or • significant stenosis, with or without symptoms. 549 patients transradial approach Patient history, the parameters of the interventions were registered prospectively. Mean age: 67±9 years, 65% men, 88% HTN, 39% DM, 72% HLP. 5
- 6. Methods – The intervention • Local anesthetics (1% Lidocain) • Intra-arterial 2.5 mg verapamil, 5,000 IU Na-heparin, 250 mcg nitroglycerin • 4F sheath for diagnostics, later change for 6 or 7F sheath • Canulation and diagnostics with Simmonds catheter • 7F guiding catheter or 6F guiding sheath • Embolic protection filter was applied, then balloon post- dilatation performed • 6 hours compression on the puncture site. 6
- 7. Results 99.8% success rate of interventions 8% femoral conversion – that ratio did not change significantly during the years. MACE: 6 cases Major vascular event: 2 cases Minor vascular event: 13 cases Days of hospitalization: median 1 day in each year. 7
- 8. Duration of the intervention 8 (sec) p=0.001 Independent samples median test p=0.013
- 9. Duration of the fluoroscopy 9 (sec) p<0.001 Independent samples median test p=0.020
- 10. Contrast material usage 10 (ml) ANOVA p=0.020 Independent samples median test p<0.001 p=0.006
- 11. Duration of the fluoroscopy- First 100 cases per center 11 Independent samples median test p<0.001
- 12. Usage of contrast material (ml) - First 100 cases per center 12 Independent samples median test p = ns.
- 13. 13 p = 0.030 Independent samples median test http://www.marmur.com/carotid-artery-stenting.html
- 14. Discussion • Significant improvement in intervention and radiation duration values, and contrast usage. • After 50 cases, the irradiation became significantly shorter. • More complicated cases were done via transradial approach with the growing experience (non- significant difference in age, co-morbidities or anatomy). 14
- 15. Conclusion The transradial carotid intervention can be applied safely. The puncture related complications are lower compared to the femoral approach. The transition to the transradial approach can be performed in 2 year in high-volume centers. 15