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SCAI Issues Best Practices for Transradial Angiography and Angioplasty from the Wrist
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Graph of transradial use in U.S.
Use of the wrist approach in the U.S. for diagnosis and treatment of heart disease has grown exponentially
October 27, 2013 -- This week the Society for Cardiovascular Angiography and Interventions (SCAI) issued an important "best practices" document, addressing the transradial approach in which diagnostic angiography and stents are guided to the coronary arteries via the radial artery in the wrist. The transradial approach, although used far more frequently in Europe, Japan and India, has increased 13-fold in the U.S. over the past five years.

The SCAI document covers a wide range of topics: for example, how to transition a hospital to the radial approach, how to avoid blocked blood flow in the radial artery (radial artery occlusion or RAO), and how to reduce radiation exposure.

However, one of the most important sections deals with the use of the radial approach in primary PCI, when angioplasty and stenting are done in the setting of ST-elevated myocardial infarction (STEMI), the most serious type of heart attack. As Dr. Jennifer Tremmel explains in the video below, the reason that the use of radial in STEMI cases is emphasized is because, while the wrist approach has many benefits, the use of radial in primary PCI is one of the best-documented advantages: numerous studies have shown better outcomes, less bleeding complications and a mortality benefit.

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. Ferdinand Kiemeneij, Sunil Rao, Mauricio Cohen, John Coppola, Shigeru Saito and Jennifer Tremmel. The section also maintains a listing of upcoming training courses in the transradial approach.

For patients there is a "Hospital Locator" that lists over 250 U.S. centers practicing radial angiography. As Dr. Howard Cohen 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!'

The "Radial Access Center for Transradial Approach" is supported by an unrestricted educational grant from Medtronic Cardiovascular.

The press release from SCAI follows:

SCAI Paper Highlights Best Practices for Diagnosis and Treating Blocked Arteries Via the Wrist

October 23, 2013 -- Washington, DC -- Today the Society for Cardiovascular Angiography and Interventions (SCAI) published a first-of-its-kind paper defining best practices for the use of the transradial approach for diagnosing and treating blocked heart arteries, which involves accessing the arteries via an artery in the wrist. Published online in Catheterization and Cardiovascular Interventions (CCI), the recommendations aim to ensure high-quality patient care as transradial access becomes the preferred technique for catheter-based procedures. Studies show a decreased risk for bleeding and vascular complications, increased patient satisfaction and reduced costs when the transradial approach is used.

During interventional cardiology procedures such as stopping a heart attack or testing for potential blockages (angiography), invasive/interventional cardiologists thread a slender tube (catheter) through an artery (traditionally in the upper leg) to reach the area they will treat or evaluate. Between 2007 and 2011,the use of the transradial (wrist-entry) approach for these procedures increased nearly ten-fold in the United States. As its popularity continues to increase, so does the need for best practices that equip physicians and institutions with tools and information to guide patient care.

"While there are a number of benefits to transradial over transfemoral approaches, there are risks associated with any procedure. By emphasizing proper training and highlighting best practices, we aim to ensure that patients receive the advantages of this approach while minimizing any potential complications," said Sunil V. Rao, M.D., FSCAI, Associate Professor of Medicine at Duke University and lead author of the consensus statement.

In developing this statement, SCAI focused on three core areas to guide physicians:

  • Best practices for avoiding blocked blood flow to the radial (wrist) artery
    Patients should be assessed prior to discharge and at the first post-procedure visit to avoid the potential for radial artery occlusion (RAO), where blood flow to the artery is blocked. Extra care also should be taken to ensure patients receive all relevant strategies for prevention of RAO.
  • Best practices for reducing potential radiation exposure to patient and operators
    To reduce the risk of exposure to radiation during a transradial procedure, the patient's accessed arm should be placed next to his or her torso, additional extension tubing should be used and operators should be cognizant of safe radiation protocols.
  • Best practices for physicians transitioning to the transradial approach when treating heart attack
    Studies have shown benefits when patients suffering a heart attack undergo angioplasty via the wrist. Steps must be taken to ensure physicians have mastered the technique before performing emergency cases routinely from the wrist. This learning process includes understanding when to revert to access through the femoral (groin) artery and how to ensure that using the radial approach does not result in delayed treatment or increased door-to-balloon time.

"These best practices are the latest example of our ongoing efforts to provide timely, useful resources to physicians as they care for patients," said SCAI 2013-14 President Ted A. Bass, M.D., FSCAI. "Our commitment to quality is consistent, as is our belief that we can always do more to improve patient care."

Download the paper, titled "Best Practices for Transradial Angiography and Intervention: A Consensus Statement from the Society for Cardiovascular Angiography and Intervention's Transradial Working Group".


Reported by Burt Cohen, October 27, 2013