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Scooped by Seth Bilazarian, MD
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Radial Access: Get Onboard or Get Left Behind

Radial Access: Get Onboard or Get Left Behind | Heart and Vascular Health | Scoop.it
Converting Holdouts to Transradial Access: This is Seth Bilazarian from theheart.org on Medscape, at the Transcatheter Cardiovascular Therapeutics (TCT) 2014 meeting in Washington, DC. I am here with Dr Sunil Rao, from Duke University and section chief at the Durham Veterans Affairs Medical Center.
Seth Bilazarian, MD's insight:

My interview with Dr. Sunil Rao on transradial (from the wrist) catheterization.  His expertise on uptake and "how - to" tips on a catheterization technique that is increasing in the US but still lags behind other parts of the world.  Requires free registration at Medscape.

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Scooped by Seth Bilazarian, MD
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Risk‐Treatment Paradox in Transradial Access for Angioplasty (PCI)

Risk‐Treatment Paradox in Transradial Access for Angioplasty (PCI) | Heart and Vascular Health | Scoop.it

Transradial arterial access significantly lowers the risk of access site complications compared to transfemoral arteriotomy. 

 We analyzed 17 509 patients who underwent PCI at 5 institutions. Transradial arterial access was used in 17.8% of patients. In those who underwent transfemoral access, 177 (1.2%) patients had access site complications. Using preprocedural clinical and demographic data, a prediction model for femoral arteriotomy complications was generated. The variables retained in the model:

- elevated age (P<0.001)

- female gender (P<0.001

- elevated troponin (P<0.001)

- decreased renal function or dialysis (P=0.002)

- emergent PCI (P=0.01)

- prior PCI (P=0.005)

- diabetes (P=0.008)

- peripheral artery disease (P=0.003).

Patients with higher predicted risk of complications via transfemoral access were less likely to receive transradial access (P<0.001). Similar results were seen in patients presenting with and without ST‐segment myocardial infarction and when adjusting for individual physician operator.

Conclusions Paradoxically, patients most likely to develop access site complications from transfemoral access, and therefore benefit from transradial access, were the least likely to receive transradial access.

Seth Bilazarian, MD's insight:

As the conclusion states: "Paradoxically, patients most likely to develop access site complications from transfemoral access, and therefore benefit from transradial access, were the least likely to receive transradial access."

Approaching heart catheterizations & angioplasty procedures from the wrist is slowly increasing in the US.  Cath labs that do not use  the radial approach in all ("Radial-first") rely on the femoral or groin approach.  In these labs, the most challenging patients that would benefit the most are not done from the wrist, because the radial approach is more challenging.  Older patients, smaller patients (women), and in circumstances when time is of the essence (like heart attacks called STEMIs)  don't get done by the radial approach so complications occur.  Unfortunately patients sometimes think they can just request this approach but if the cardiologist and/or cath lab  is not skilled in this technique using the femoral approach is still better.

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