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

Early (immediate?) ambulation 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

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