Sunday, March 30, 2008

How long does it take for us to change?

Oh no, I am not writing about political change in Malaysia following 838. I am talking about interventional cardiologist and their willingness to change. As we all know, we were all trained to do coronary angiogram and angioplasty via the femoral approach? The transfemoral route was the more popular route and then Campeau and later Kiemeneij, started to popularised the transradial route. For those of us who studied the safety profile, we found that the transradial artery route (TRA), was safer, especially from the patient bleeding point of view. I also found that elderly men with prostatic problems found the TRA route more convenient and comfortable. It is also true to mention that the TRA route has a learning curve and needed some practice. Despite the many advantages of TRA, many good interventionist still shy away and only use TRA when they have no choice, resulting in them having difficult TRA procedures, and making them further reluctant to use the TRA. The recent online publication of HEART journal, the Canadians reviewed their 30,000 patients who had TRA from 1999-2005. They reported that the TRA route was obviously safer and the patients obviously required less blood transfusions. Having just return from participating in the "China Interventional Therapeutics 2008 " meeting at Beijing, it is obvious from our discussion with our Chinese counterparts there, that TRA is much safer and many certers are doing 50-60 % of their cardiac procedures using the TRA route. So also are the Japanese. I am still awaiting to see how many interventionist in Malaysia will embrace the TRA route. At the moment, my observations are that about 20-30% of all interventions done in Malaysia use the TRA route. Anyway, how long will it take for us to change for the better TRA route. We shall see.

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