Transcript Transradial interventions -local perspective Dr Syed Nadeem Hassan Rizvi, MBBS (Pb), Dip Card (lon) , MRCP(UK), FSCAI As.

Transradial interventions
-local perspective
Dr Syed Nadeem Hassan Rizvi,
MBBS (Pb), Dip Card (lon) , MRCP(UK), FSCAI
As. Professor of Cardiology,
National institute of Cardiovascular diseases,
Karachi
Why Transradial ?
 Early
(immediate?) ambulation
 Less local complications than
transfemoral
 Less ‘labour / staff ’ intensive
Downside of transradial
 Steep
learning curve
 Limited availability of specific radial
catheters at present
 Access limited upto 7F in most
patients , which therefore, excludes
certain techniques e.g simultaneous
stenting and IABP insertion
TRI-Preparation
TRI-Preparation
TRI-Preparation
TRI-Preparation
TRI-Final table setup
TRI- Local anaesthetic
TRI- Access
TRI- Access
TRI- Access
TRI - Access
TRI- Sheath removal
TRI- Access closure / TR band
TRI- Access closure / TR band
TRI – TR band closure
TRI- Immediate ambulation
TRI- Material
Easy Radial
Radistop
Gauze and tape/ bandage
Stepty P
Radstat
TRI- Diagnostic catheters
TRI- Guiding catheters
Guide catheters
Fadajet (Cordis)
Muta wiseguide (BSS)
Kimney Runway (BSS)
Mann IMA (BSS)
Radial curve (BSS)
Radial / brachial anatomy
JR for LCA
TRI- Primary PCI
TRI- Primary PCI
TRI- Primary PCI
TRI – Kissing balloon (6F access)
TRI- bifurcation PCI
TRI – bifurcation PCI
TRI – Complex rescue PCI
TRI – Complex rescue PCI
Radial fluro times
NICVD JAN'07-FEB'08
av= 14min
-7 va l ues >20mi n
av=9.6min
time(min)
50
40
30
20
10
0
1
3
5
7
9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43
patient
Femoral fluro times
NICVD JAN'07-FEB'08
av=9.7min
-7 val ues>20mi n
av= 7.5min
time(min)
80
60
40
20
0
1
5
9 13 17 21 25 29 33 37 41 45 49 53 57 61 65 69 73 77 81 85 89
patient
Conclusion I
 TRI
is a safe and effective procedure
 Has a steep learning curve and
therefore needs persistence and
dedication to master technique
 Variety of specific hardware is limited
in Pakistan mainly due to low volumes
Conclusion II
Fluro times are marginally longer than
femoral procedures but usually decline
with increasing expertise
 No specific subgroup should be exempted
from this technique except those where
>7F diameter access is necessary
 Teaching institutes should try and adopt
this technique as ‘first line’ due to its safety
and cost effectiveness

Thank You