Transradial is one of the big buzzwords in interventional cardiology these days. In the United States practitioners recently have been discovering its advantages and have been learning how to perform it successfully. Utilization of transradial in the U.S. has jumped from 2% to almost 25% in less than a decade. In Europe, Japan, India, and China, transradial has been used for years and in most of those regions adoption runs from 50-90% of all catheter-based procedures. In Japan, and now in Europe, a specialized group of physicians has been pushing the limit of what can be done via the wrist artery, using “slender” procedures and equipment, with systems using 3, 4 and 5F sized catheters.
But the heart (pun intended) of this revolution in catheter-based access goes back over two decades to the pioneering work done by Dr. Ferdinand Kiemeneij, rightly dubbed “the father of transradial intervention.” You can read my interview with Dr. Kiemeneij here, but more importantly, you can and should and must read his brand-new hot-off-the-press book, “Transradial Coronary Interzentions,” available on Amazon.
Dr. Kiemeneij has been actively involved in the refinement of the transradial technique since he developed it. He travels extensively, especially in China and Japan, works with cath labs worldwide, has brought the Japanese-based Slender Club to Europe, has studied and has a degree in sinology, is an avid (and excellent) photographer, and, oh yeah, does that new social media stuff, too (twitter handle is @ferdikiem).
One of the biggest reasons he promotes transradial is the safety and comfort it affords the patient. Kiemeneij designed one of the first “radial lounges” at his former hospital, OLVG in Amsterdam, and is now doing the same at Tergooi, where he currently practices.
I recently visited OLVG with Dr. Giovanni Amoroso and got to see him perform a transradial multivessel PCI. The patient was on the cath lab table, dressed in her regular clothing, and after the procedure, by the time we looked at the results and walked down the hall into the radial lounge, she was already there, sitting at a table, chatting with her husband and relatives. She went home later that afternoon!
With this focus on the patient and patient comfort that this technique affords, the whole experience of getting a PCI changes: for both the doctor and the patient. There are many implications generated by transradial and the future of the way interventions are done will be altered by its adoption. Hospital systems, especially in the U.S., will have to change.
But also physicians’ attitudes will. And this is why Dr. Kiemeneij’s new book is so important. In it he brings together a whole range of concepts that he has explored and has been practicing, and insights that have come from his experiences both inside and outside the hospital. I quote from his note to me:
“This book is one of a kind and focuses more on the ‘soft sides’ of interventional cardiology (mindset, preparations, minimally invasive, traceless, minimal use of materials). I bring Taoist and Zen core values into the cath lab. The book is illustrated by many B&W photos that I have made during my frequent travels. I am convinced that these views are especially of value for young interventionalists. I hope you can pay some attention to this work, which I consider to be the summit of my work.”
And here’s the book synopsis from Amazon:
Transradial Coronary Interzentions
Paperback – May 7, 2016
by Ferdinand Kiemeneij (Author)
What are you aiming at when performing a coronary intervention? Is your target a zero percent residual stenosis and normal coronary flow? Or are you aiming at a perfect procedure? This unique book by Ferdinand Kiemeneij, pioneer of transradial coronary interventions, combines his insights on how to optimize a transradial coronary angioplasty procedure with the most precious values of Taoist and Zen philosophies. The book is so richly illustrated with his black & white photos that it can be considered as a photo book as well. After a very short introduction into the history and principles of Taoism and Zen, the author brings some core values into the catheterization laboratory. In the end you will understand that, to quote Herrigel: “The target is not the rose, but that the arrow leaves the arch as a leaf falls from the tree. Effortless and relaxed, without aiming it will succeed. If you shoot like this, you cannot miss because you and the target are one.” Ferdinand Kiemeneij, MD, PhD, is interventional cardiologist and sinologist and lives in Bussum, the Netherlands.
In the U.S. we speak of “patient-centered” or “hospital-centered”: a dichotomy. Perhaps, as Dr. Kiemeneij suggests, these are not opposing entities, because “you and the target are one.”
Seriously, how can you practice transradial (or even other) PCI and not read this book? Dr. Kiemeneij calls it “the summit of my work.” It’s even got beautiful pictures!
Did I mention you can buy it on Amazon?