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Angioplasty and Stenting from the Wrist: Society for Cardiovascular Angiography and Intervention (SCAI) Issues Its First Report on Transradial Access
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Transradial Arterial Access for Coronary and Peripheral Procedures (PDF)
-- SCAI Transradial Working Group

Radial artery diagram    

May 5, 2011 -- The Society for Cardiovascular Angiography and Intervention (SCAI) released its first official report on transradial (wrist) access for angioplasty and stenting at its annual meeting, being held in Baltimore, MD this week. Published simultaneously in Catheterization and Cardiovascular Interventions, the 17-page report covers a wide range of topics, such as patient selection and preparation, artery access, catheter and therapy selection, primary PCI, potential complications and training for interventional cardiologists performing procedures via radial access.

Ever since cardiac catheterization was first utilized to diagnose coronary artery disease in the 1960's, cardiologists and device companies have tried to make the procedure easier to perform and safer for patients. The two founders of SCAI were also inventors of the two most widely used techniques at the time: the brachial approach, used by Dr. Mason Sones and the femoral approach, perfected by Dr. Melvin Judkins (still the major approach used worldwide). These pioneers combined forces in 1978 to create an organization that championed and facilitated quality and safety in cardiac imaging. So it is only fitting that the first overview of this alternate technique from a professional medical society in the U.S. was made by SCAI.     Mason Sones and Melvin Judkins: Founders of SCAI
Mason Sones and Melvin Judkins: Founders of SCAI

As has been written in these pages for some time now, the transradial approach, where angioplasty and stenting is done from the radial artery in the wrist, is not exactly new. It has been practiced in Canada, Europe and Asia for well over a decade and currently accounts for half of the catheter-based procedures performed in Europe. But in the United States, the transradial technique is relatively new: only about 5% of procedures are done this way.

But the technique is rapidly catching on because of its benefits regarding patient comfort, rapid ambulation and lower bleeding complications. One of the challenges therefore is training -- making sure that cardiologists learn the correct way to perform transradial procedures.

Dr.  Ronald Caputo
Dr. Ronald Caputo

These concerns were stated by Ronald P. Caputo, M.D., FSCAI, the report's lead author and Director of Cardiac Services, St. Joseph's Hospital in Syracuse, NY. He stated:

"Data increasingly show that the radial technique, which many patients find more comfortable, is also safe and effective.... As this technique is used more frequently in the United States, we want to ensure it is used safely and appropriately."

Regarding training, the report recommends three levels of competency, based on the individual interventional cardiologist's level of experience with simple and complex cases, including patients with challenging anatomy. The authors emphasize that interventional cardiology trainees should develop equal competency in both femoral and radial approaches, and guidelines should be developed to address best practices for safe use of the radial technique.

"To ensure patients receive the best possible care, we recommend developing training programs that provide interventional cardiologists with opportunities to learn and test their skills in the radial technique," said Jennifer A. Tremmel, M.D., M.S., FSCAI, report co-author and Director of the Transradial Program at Stanford University Medical Center in Stanford, CA.

And SCAI has been sponsoring training programs over the past six months: in Boston, Philadelphia and coming up in Los Angeles. In addition, various hospital centers and physicians with experience in the radial technique are also sponsoring one or two day workshops. A complete list can be found in Angioplasty.Org's Radial Training Courses.

The authors of the report on Transradial Angioplasty (TRA) conclude:

"TRA for percutaneous revascularization has seen steady growth worldwide since the initial experience described by Campeau in 1989. Benefits to TRA include a lower incidence of access site and bleeding complications, higher patient satisfaction, and potentially lower overall costs compared to transfemoral access. TRA has been successfully utilized for a variety of indications including primary PCI, bypass graft angiography and PCI, and noncoronary revascularization. However, guidelines regarding training and competency are lacking, and will need to be more clearly defined as the current trend of increasing adoption continues in the United States."

About The Radial Access Center on Angioplasty.Org
To assist in educating the professional and patient population in the U.S. about the this technique, Angioplasty.Org created the "Radial Access Center for Transradial Approach" in 2007, a special section devoted to information and news about the transradial technique, for both patients and physicians. The Radial Center features interviews with leading practitioners of the radial technique, such as Drs. Jeffrey Popma, Sunil Rao, Mauricio Cohen, John Coppola, Shigeru Saito and Jennifer Tremmel.

For interventional cardiologists and cath lab staff, Angioplasty.Org also maintains a listing of upcoming training courses in the transradial approach. For patients, there is a unique "Radial Hospital Locator" that lists U.S. centers practicing radial angiography. As Dr. Howard Cohen of Lenox Hill Hospital in New York says of the wrist technique, "Patients really prefer it. 95% of people who've had it both ways would say 'I'm coming back to you, Dr. Cohen because I like this transradial a lot better than the other way!'

Reported by Burt Cohen, May 5, 2011