Best Practices for Transradial Angiography and Intervention
This update highlights best practices for transradial angiography and intervention, including topics such as ultrasound guidance for transradial access, ulnar artery access recommendations, and future study opportunities. The importance of developing proficiency with ultrasound guidance, utilizing real-time guidance during challenging access, and considering ulnar artery as a secondary access site are emphasized. The article also discusses optimal anticoagulation strategies, distal radial access, hand dysfunction, and potential use of the radial artery as a conduit. Recommendations aim to improve outcomes and guide specific practices in transradial procedures.
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TRIP: Radial Access and Beyond TRIP: Radial Access and Beyond SCAI Update on Transradial Angiography and Intervention Best Practices Adhir Shroff, MD, MPH Associate Professor of Medicine University of Illinois Chicago Jesse Brown VA Medical Center arshroff@uic.edu @ARS_MD2004 #RadialFirst
Disclosure Statement of Financial Interest Within the past 12 months, I have had a financial interest/arrangement or affiliation with the organization(s) listed below. Consulting Fees/Honoraria/Speakers Bureau: Terumo Cordis Abiomed Medtronic Equity Interests: None Royalty Income/Intellectual Property Rights: None Salary/Salary Support/Employee: None
TR Best Practices Topics covered based on quality of evidence to guide a specific practice Ultrasound guidance for TRA Ulnar artery access Utility of routine, non-invasive assessment of collateral flow Update on RAO prevention TRA for primary PCI Future study Optimal anticoagulation strategy Distal radial access Hand dysfunction Use of the radial artery as a future conduit Catheter Cardiovasc Interv. 2020 Feb;95(2):245-252
Ultrasound guidance for TRA - Recommendations 1. Operators should develop proficiency with ultrasound guidance 2. Real-time ultrasound guidance should be used when difficulty with radial access is encountered or expected Catheter Cardiovasc Interv. 2020 Feb;95(2):245-252
RAUST JACC Cardiovasc Interv. 2015 Feb;8(2):283-291
Ulnar Artery Access - Recommendations 1. Radial artery is preferred over ulnar artery in most situations 2. UA is a reasonable alternate site when risks RA complications are high 3. Ipsilateral UA is reasonable secondary access site after failed radial access 4. In cases of known RAO, insufficient data to provide a recommendation for ipsilateral UA access over contralateral RA or TFA Catheter Cardiovasc Interv. 2020 Feb;95(2):245-252
Ulnar Artery Studies Catheter Cardiovasc Interv. 2020 Feb;95(2):245-252
Utility of routine, non-invasive assessment of collateral flow - Recommendations 1. TR catheterization can be performed safely regardless of results of non-invasive testing. Routine collateral testing should NOT be used as a triage tool for access site selection 2. Collateral testing may be useful for assessment of RAO post- procedure Catheter Cardiovasc Interv. 2020 Feb;95(2):245-252
Update on RAO prevention -Recommendations Updated or New recommendations 1. IV or IA UFH 5,000u or 50u/kg or a higher dose is recommended 2. Concomitant ipsilateral UA compression is recommended Continued recommendations 1. Lowest profile sheath and/or catheter system 2. Patent hemostasis should be the default strategy Catheter Cardiovasc Interv. 2020 Feb;95(2):245-252
New RAO Studies SPIRIT of ARTEMIS: 100u/kg vs 50 u/kg UFH PROPHET II: Routine ulnar compression JACC Cardiovasc Interv. 2018 Nov 26;11(22):2241-2250 JACC Cardiovasc Interv. 2016 Oct 10;9(19):1992-1999
TRA for Primary PCI - Recommendations 1. TRA can (should) be used for primary PCI to reduce vascular complications and bleeding 2. Operators should be experienced with non-emergent TR-PCI 3. Defined strategies for arterial access site cross-over must be in place Catheter Cardiovasc Interv. 2020 Feb;95(2):245-252
MATRIX European Heart Journal (2017) 38, 1069 1080
Take Home Points Transradial practice has developed rapidly over the past 10 years Best Practice Statements hope to integrate clinical data into recommendations on practice Improve adoption of proven techniques and practices (contrary is true as well) Decrease practice variation Improve outcomes
Questions????? Thank you. arshroff@uic.edu @ARS_MD2004 312-485-4511
