Friday, October 03, 2008

TRANSRADIAL PCI


We may be witnessing a change in the prefered way to do coronary angiogram and coronary interventions. By this I mean that more and more US interventional cardiologist are using the transradial ( wrist ) site to perform their procedures. The graph on the left shows the continual rise in the use of the transradial approach in their patients.
We were all taught, in the 70's to do our coronary procedures via the transfemoral ( thigh ) approach. Actually, it was Dr Mason Sones who performed the frirst coronary angiogram, and he did it transbrachial ( elbow ). That was in the 60's. Following Sones, Dr Melvin Judkins taught us the transfemoral approach, and all the coronary catheters were preshaped for the transfemoral approach. In the 80's, Dr Campeau of Canada, did the first transradial coronary angiogram, and in 1992, Dr Kimeneij and colleagues in Amsterdam, started doing angiograms and coronary interventions through the transradial approach. The technique caught on very quickly in Japan, India and Europe, while the Americans hang on to their transfemoral approach.
We started our transradial experience in the mid-90's. Now we are doing almost all ( about 90% ) of our coronary procedures transradial ( TRI ). It is interesting that the Americans are catching up now.
The radial artery is present on the outside border of our wrist. It is a smaller artery and requires some training and practice, before a cardiologist can become comfortable with it. We call it a learning curve. The radial artery can be safely cannulated, as long as there is a large enough ulnar artery to compensate. In the absence of a large enough ulnar artery, it may not be save to use the radial artery. The other problem with the radial artery is of course, its size. When we measured, Malaysian radial arteries are about 2.5-3.0mm in diameter. That means that certain kind of coronary interventions ( those that require catheters larger than 3.0mm ) cannot be savely done via the radial artery. Of course the big advantage with the transradial approach is that the bleeding is much, much less when compared to the transfemoral approach. That means less blood transfusions and therefore less mortality. This was shown in many clinical comparison studies. In the local context, the transradial approach patient is also easier to nurse. The patient is much more independent and bleeding is a minor and rare problem.
I am very happy with the transradial approach. I must have done hundreds, or maybe thousands, by now ( I stopped counting at about 200 ). The patients are also happy. They can ambulate much earlier and maybe discharged on the same day.
Terumo has been very helpful, worldwide, in conducting courses in TRI. Locally, they are also very supportive with new TRI catheters and also TRI wristbands. They are also helping us to conduct TRI courses to further promote this technique. This is another instance of industry and doctors working together for the benefit of our patients.
Nexttime should you or your love ones need an angiogram or intervention, ask your doctor to do it transradial. If not for any reason, but to know how updated your cardiologist is.

2 comments:

francisj said...

Glad to see that you are popularising transradial interventions in your blog. As you mentioned the learning curve is a bit steep. Radial artery spasm used to be problem initially. Another practical advantage for the operator is that certain guide catheters are available which can be used for both right and left coronary artery so that there is no need for catheter exchange during two vessel angioplasty. This reduces the chance for spasm.

Cardiophile MD (www.cardiophile.org)

francisj said...
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