Transradial interventions -local perspective

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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 - PowerPoint PPT Presentation

Text of Transradial interventions -local perspective

  • Transradial interventions-local perspective

    Dr Syed Nadeem Hassan Rizvi,MBBS (Pb), Dip Card (lon) , MRCP(UK), FSCAIAs. Professor of Cardiology, National institute of Cardiovascular diseases,Karachi

  • Why Transradial ?Early (immediate?) ambulationLess local complications than transfemoralLess labour / staff intensive

  • Downside of transradialSteep learning curveLimited 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 Radistop Radstat Stepty PEasy Radial Gauze and tape/ bandage

  • TRI- Diagnostic catheters

  • TRI- Guiding catheters

  • Guide catheters Radial curve (BSS) Muta wiseguide (BSS)Fadajet (Cordis)Kimney Runway (BSS)Mann IMA (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

  • Chart6

    21.4

    5.5

    58.6

    12.7

    4.2

    7.3

    5.6

    2.7

    10.1

    4.7

    5

    3.2

    15.5

    9.2

    9.3

    11.8

    3.4

    4

    8.4

    3.1

    1.8

    12.9

    5.6

    7.2

    6.6

    9.2

    5.9

    4.3

    6.8

    6.4

    3.8

    11.5

    3.8

    2.7

    3.8

    6.5

    4.7

    8.4

    3.8

    5.6

    5.9

    2.3

    19.1

    5.1

    6.8

    17

    5.4

    5.5

    4.6

    3.2

    4.5

    1.3

    2.2

    7.1

    15.8

    11.3

    5.9

    12.2

    11.7

    9

    4.1

    6.6

    7.7

    2.8

    7.2

    20.6

    28.6

    10.9

    4.6

    11

    47.3

    12.5

    27

    37.7

    16.2

    7.4

    29.9

    4.9

    6.7

    3.3

    5.1

    9.7

    19.4

    3.2

    17.9

    7.5

    5.5

    6.7

    9.8

    patient

    time(min)

    Femoral fluro timesNICVD JAN'07-FEB'08av=9.7min -7 values>20min av= 7.5min

    Sheet1

    3221.4

    8.55.5

    3.358.6

    512.7

    164.2

    8.77.3

    1.95.6

    4.52.7

    6.310.1

    13.94.7

    6.45

    3.23.2

    4.215.5

    15.89.2

    439.3

    7.811.8

    25.13.4

    26.74

    5.38.4

    11.33.1

    7.91.8

    1512.9

    10.55.6

    9.57.2

    10.96.6

    9.69.2

    22.75.9

    11.44.3

    3.86.8

    116.4

    30.13.8

    12.111.5

    73.8

    6.82.7

    7.83.8

    20.56.5

    11.24.7

    10.28.4

    7.93.8

    15.15.6

    10.85.9

    44.12.3

    20.619.1

    16.45.1

    6.8

    17

    5.4

    5.5

    4.6

    3.2

    4.5

    1.3

    2.2

    7.1

    15.8

    11.3

    5.9

    12.2

    11.7

    9

    4.1

    6.6

    7.7

    2.8

    7.2

    20.6

    28.6

    10.9

    4.6

    11

    47.3

    12.5

    27

    37.7

    16.2

    7.4

    29.9

    4.9

    6.7

    3.3

    5.1

    9.7

    19.4

    3.2

    17.9

    7.5

    5.5

    6.7

    9.8

    581.8

    Sheet1

    radial

    femoral

    No of patients

    time(min)

    Radial and femoral fluro times

    Sheet2

    patient

    time(min)

    Radial fluro times NICVD JAN'07-FEB'08av= 14min -7 values >20min av=3.6min

    Sheet3

    patient

    time(min)

    Femoral fluro timesNICVD JAN'07-FEB'08av=9.7min -7 values>20min av= 7.5min

    Chart1

    32

    8.5

    3.3

    5

    16

    8.7

    1.9

    4.5

    6.3

    13.9

    6.4

    3.2

    4.2

    15.8

    43

    7.8

    25.1

    26.7

    5.3

    11.3

    7.9

    15

    10.5

    9.5

    10.9

    9.6

    22.7

    11.4

    3.8

    11

    30.1

    12.1

    7

    6.8

    7.8

    20.5

    11.2

    10.2

    7.9

    15.1

    10.8

    44.1

    20.6

    16.4

    patient

    time(min)

    Radial fluro times NICVD JAN'07-FEB'08av= 14min -7 values >20min av=9.6min

    Sheet1

    3221.4

    8.55.5

    3.358.6

    512.7

    164.2

    8.77.3

    1.95.6

    4.52.7

    6.310.1

    13.94.7

    6.45

    3.23.2

    4.215.5

    15.89.2

    439.3

    7.811.8

    25.13.4

    26.74

    5.38.4

    11.33.1

    7.91.8

    1512.9

    10.55.6

    9.57.2

    10.96.6

    9.69.2

    22.75.9

    11.44.3

    3.86.8

    116.4

    30.13.8

    12.111.5

    73.8

    6.82.7

    7.83.8

    20.56.5

    11.24.7

    10.28.4

    7.93.8

    15.15.6

    10.85.9

    44.12.3

    20.619.1

    16.45.1

    6.8

    17

    5.4

    5.5

    4.6

    3.2

    4.5

    1.3

    2.2

    7.1

    15.8

    11.3

    5.9

    12.2

    11.7

    9

    4.1

    6.6

    7.7

    2.8

    7.2

    20.6

    28.6

    10.9

    4.6

    11

    47.3

    12.5

    27

    37.7

    16.2

    7.4

    29.9

    4.9

    6.7

    3.3

    5.1

    9.7

    19.4

    3.2

    17.9

    7.5

    5.5

    6.7

    9.8

    581.8

    Sheet1

    radial

    femoral

    No of patients

    time(min)

    Radial and femoral fluro times

    Sheet2

    patient

    time(min)

    Radial fluro times NICVD JAN'07-FEB'08av= 14min -7 values >20min av=9.6min

    Sheet3

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

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    0

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    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

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    0

    0

    0

    0

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    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

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    0

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    0

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    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    patient

    time(min)

    Femoral fluro timesNICVD JAN'07-FEB'08av=9.7min -7 values>20min av= 7.5min

  • Conclusion ITRI is a safe and effective procedureHas a steep learning curve and therefore needs persistence and dedication to master techniqueVariety of specific hardware is limited in Pakistan mainly due to low volumes

  • Conclusion IIFluro 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 necessaryTeaching institutes should try and adopt this technique as first line due to its safety and cost effectiveness

  • Thank You

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