Transradial is everywhere: the widely attended transradial concurrent session at TCT, lectures at the Women in Interventional Program, headlines on theheart.org interventional page, and most recently the SCAI Radial Summit held in Boston on November 7th. The benefits are numerous including lower access bleeding, lower overall complications, earlier ambulation/discharge, and lower hospital costs overall. The reservation to use a radial approach includes lack of training, increased procedure time, and increased radiation – all of which should decrease with experience.
As someone who did < 10% of cases from a transradial approach in training and is now trying to increase that number as the primary operator under the guidance of experts around the country (by telephone), I have definitely had some trials and tribulations: Most recently I did a diagnostic catheterization on 23 years old woman with an NSTEMI. Despite the use of antivasospasm agents and sedatives, she had such severe radial spasm during the diagnostic angiogram that I was unable to move the catheter, forward or backward. I had never heard of spasm to that extent. After a significant amount of time and medications, I was able to pull the catheter out by twisting the catheter as I walked it out. Since that case, I have spent a lot of time on “transradial websites” and online conferences to read about possible complicating issues using radial access and any tips possible to address them. I hope we can use this blog as a forum to share such experiences. – Sohah N. Iqbal, MD WINExchange Co-editor