Using Large Bore Catheters via the Radial Approach

By Paul Williams

Transradial access for coronary intervention is rapidly increasing in popularity worldwide but, despite the many advantages of this approach, the small calibre of the radial artery is considered by some to be a major limitation to performing complex PCI requiring large bore (> 6 French) guide catheters. However many radial arteries will readily accept a 7 French (Fr) sheath and the introduction of newer technologies such as 7.5 Fr sheathless guide catheters (with an external diameter smaller than a 6 French sheath) may allow even these complex cases to be performed routinely via a transradial approach.

In this study 55 true coronary bifurcation lesions were scheduled to be treated using conventional crush stenting using 7 French sheaths via the transradial approach. Successful transradial crush stenting was performed in 93% patients and successful transradial 2-stent bifurcation PCI was performed in 96% patients. There were no procedural or in-hospital complications.

This study demonstrates that complex PCI requiring large bore catheters can be performed successfully in a very high proportion of patients via the transradial approach. As there is an increased risk of femoral vascular complications with large sheaths, the radial artery may represent the preferable vascular access site for patients undergoing complex PCI requiring large bore guide catheters.

Williams PD, Eichhöfer J, Mamas MA,  Arnous S, Fath-Ordoubadi F,  Fraser D. Transradial Intervention via Large-Bore Guide Catheters: A Study of Coronary Bifurcation Disease Treatment Using the Crush Technique. J INVASIVE CARDIOL 2013;25(9): 455-459

A selection of articles on transradial approach from the Journal of Invasive Cardiology:

Tobita K, Takeshita S, Saito S. The 4-in-5 Mother-Child Technique: 5 Fr Transradial Coronary Intervention for Complex Lesions Using a 4 Fr Child Catheter. J INVASIVE CARDIOL 2013;25(8):406-408

Launching a Successful Transradial Program
Jennifer A. Tremmel, MD, MS
Stanford University Medical Center, Stanford, California.

Learning Curve in Transradial Cardiac Catheterization: Procedure-Related Parameters Stratified by Operators’ Transradial Volume
Ehab S. Kasasbeh, MD, Babar Parvez, MD, Robert L. Huang, MD, Michele Marie Hasselblad, MSN, RN, Mark D. Glazer, MD, Joseph G. Salloum, MD, John H. Cleator, MD, PhD, David X. Zhao, MD    J INVASIVE CARDIOL 2012;24(11)

Successful Transradial Intervention by Switching from 6 French to 5 French Guiding Catheter
Takashi Matsukage, MD, PhD, Naoki Masuda, MD, Yuji Ikari, MD, PhD
Tokai University School of Medicine, Isehara, Japan.

Safety and Efficacy of Transradial Access in Coronary Angiography: 8-Year Experience 
Xavier Carrillo, MD, Josepa Mauri, MD, PhD, Eduard Fernandez-Nofrerias, MD, Oriol Rodriguez-Leor, MD, Antoni Bayes-Genis, MD, PhD

Radial Artery Spasm: Pick the Right Cocktail and Relax
Anupama Shivaraju, MD and Adhir Shroff, MD, MPH

Cost-Effectiveness of the Radial versus Femoral Artery Approach to Diagnostic Cardiac Catheterization
Oleg Roussanov, MD, S. Jeanne Wilson, RN, Katherine Henley, FNP, Greta Estacio, FNP,
Judith Hill, FNP, Brenda Dogan, RN, William F. Henley, PhD, Nabil Jarmukli, MD

Abstracts from AIM RADIAL 2012: 1st Advanced International Masterclass. September 13-15, 2012 /  Québec City, Canada.    Read about the transradial programs in France, Japan, Israel, Greece, Canada, Italy, Hungary, Czech Republic, United States, and United Kingdom.

1st Advanced International Masterclass – AIM-RADIAL 2012: Building a Community Spirit to Reach Excellence in Education and Research About Transradial Approach!  Olivier F. Bertrand, MD, PhD on behalf of the Organizers






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