A note from Dr. Richard Shaw, Editor-in-Chief
To provide more in-depth coverage of this important area, we are introducing a new section of the Journal that will focus on peripheral vascular disease. It is my pleasure to introduce Dr Jihad Mustapha as the new section editor. Dr Mustapha is Director of the Cardiovascular Catheterization Laboratories, Director of Endovascular Interventions, and Director of Cardiovascular Research at Metro Health Hospital in Wyoming, Michigan and Clinical Assistant Professor at Michigan State University School of Medicine. This issue of the Journal begins the series with an article from Drs Roberto Lorenzoni and Marco Roffi reviewing the use of transradial access for peripheral and cerebrovascular interventions.
Radial Artery Access: An “All Seasons” Approach
by Dr. Roberto Lorenzoni
Radial access has gained acceptance for coronary interventions over traditional femoral access, since it provides the same results on target lesions with fewer local complications. At our center, we shifted from femoral to radial access for coronary interventions in 2004. In 2009, we decided to implement radial access for interventions on lower limb arteries as well. After that preliminary experience,(1) we approached all above-the-knee lesions (except long occlusions of the superficial femoral artery) by radial access, with good results: 100% success rate on superficial femoral artery stenosis, 98% success rate on iliac stenosis, 63% success rate on iliac occlusions (Figure 1). In 2012, we published an article that outlined the materials and techniques we used for performing lower-extremity artery angioplasty by radial access.(2)
In the October issue of the Journal of Invasive Cardiology, we show that radial access can be used for all other non-coronary interventions.(3)
We describe the technique and the materials for doing carotid artery stenting by radial access when femoral access is not feasible; but right radial artery can be used as first choice access in particular anatomical situations such as left carotid artery stenting in bovine arches.(4)
We show that radial access can become preferable for renal stenting, independently of the suitability of femoral access.(5) In fact, renal arteries often have a downsloping emergence from aorta and are best cannulated and stented from above. We now perform all renal artery interventions by radial access and we are planning to use this access also for renal artery denervation.
Figure: Right external iliac artery occlusion treated successfully with stenting by left radial artery access.
- Lorenzoni R, Mazzoni A, Lazzari M, Boni A, Gemignani C, Bovenzi F. Radial artery access for above the knee angioplasty: a feasibility study. EuroIntervention. 2011;7(8):924-929.
- Lorenzoni R, Lisi C, Lazzari M, Bovenzi F. Tools & techniques: Above the knee angioplasty by transradial access. EuroIntervention. 2012;7(9):1118-1119.
- Lorenzoni R, Roffi M. Transradial Access for Peripheral and Cerebrovascular Interventions. J Invasive Cardiol. 2013;25(10):529-536.
- Etxegoien N, Rhyne D, Kedev S, Sachar R, Mann T. The transradial approach for carotid artery stenting. Catheter Cardiovasc Interv. 2012;80(7):1081-1087.
- Trani C, Tommasino A, Burzotta F. Transradial renal stenting: why and how. Catheter Cardiovasc Interv. 2009;74(6):951-956.
- Yu J, Korabathina R, Coppola J, Staniloae C. Transradial approach to subclavian artery stenting. J Invasive Cardiol. 2010 May;22(5):204-6.
- Cohen MG, Alfonso C. Starting a Transradial Vascular Access Program in the Cardiac Catheterization Laboratory. J Invasive Cardiol. 2009;21(Suppl A):11A–17A.
- Tremmel JA. Launching a successful transradial program. J Invasive Cardiol. 2009 Aug;21(8 Suppl A):3A-10A.
- Caputo RP. Transradial Arterial Access: Economic Considerations. J Invasive Cardiol. 2009;21(Suppl A):18A–20A