ThinkRadial Newsletter Vol. 1

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In this Issue: Preserving the Radial Artery. A popular topic of discussion among new, veteran and yet-to-be radial practitioners is how best to preserve the radial artery. Radial artery occlusion (RAO) has been described as the “Achilles’ heel” of the transradial technique1 and therefore radialists must take certain precautions to preserve the radial artery. In this issue we focus on topics relevant to preserving the radial artery including reuse, patent hemostasis, the selection of medical devices and anticoagulants.

Newsletter Table of Contents

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Register for a Live webinar with Dr. Morton Kern and Radial Expert Colleagues

Topic: Radial Tips and Techniques. Receive tips for setting up your radial lab, negotiating shoulders and the use ultrasound, among others.
Date and Time: Wednesday, October 21 at Noon PT (3pm ET) for one hour.
Format: Brief presentation by Dr. Kern and his radial expert colleagues Dr. Mladen Vidovich, Chief of Cardiology at Jesse Brown Veterans Administration Medical Center in Chicago, Illinois and Dr. John Lassetter, Cardiologist at Eastern Idaho Cardiology Associates in Idaho Falls, Idaho. Attendees can ask questions that will be answered by the panel.
Registration is open to any clinician interested in learning about radial approach or already practicing radial approach. The content is suitable for all practice levels and the very seasoned panel will answer questions from attendees.
Register Here TodayDR_Kern-180x180

About Dr. Morton Kern
Dr. Kern is a currently a Professor of Medicine and Chief Cardiology LBVA, Associate Chief Cardiology UCI at the University of California, Irvine in Orange, California. He has been recognized as one of the top cardiologists in the United States and is the author of several major textbooks, including the leading book on cardiac catheterization, “The Cardiac Catheterization Handbook.” Read more.

 

 


 

Suggested Articles and Literature

Radial Artery Use and Reuse – Preserving radial patency after transradial catheterization procedures.  Sameer Gupta, MD, and Sandeep Nathan, MD, MSc
Cardiac Interventions Today. (May/June 2015)

Article addresses the primary safety concern of radial artery reuse – radial artery occlusion (RAO). Highlights practical issues related to prevention, detec­tion and treatment of RAO and addresses evidence-based best practices that are particularly relevant to treating patients who undergo repeated use of the radial artery for catheter-based procedures.

http://citoday.com/2015/06/radial-artery-use-and-reuse/

Radial Artery Patency after Transradial Catheterization  Mark A. Kotowycz, MD, MBA, FRCPC; Vladimír Dzavík, MD, FRCPC, FAHA
Circulation: Cardiovascular Interventions. (2012)

RAO many times is clinically silent and overlooked and more than 50% of transradial operators do not routinely assess radial artery patency before hospital discharge. Once the artery is occluded, it cannot be used as an access site for future catheterization or as an arterial conduit for bypass surgery. This report from 2012 reviews risk factors and prevention and treatment options for RAO. The article includes a section dedicated to Anticoagulation.

http://circinterventions.ahajournals.org/content/5/1/127.full.pdf+html

Patent Hemostasis – Ask the Experts: Is Patent Hemostasis After Radial Access Truly Valuable?
Ian C. Gilchrist, MD, FSCAI; Kimberly Skelding, MD, FACC, FAHA, FSCAI; and Jennifer A. Tremmel, MD, MS
Cardiac Interventions Today. (May/June 2015)

Three radial experts weigh in that patent hemostasis is key in preventing radial artery occlusion and ensuring continued radial use in the future.

http://citoday.com/2015/06/ask-the-experts-is-patent-hemostasis-after-radial-access-truly-valuable/

NewsESC Guidelines recommend radial approach for percutaneous coronary interventions in ACS
Press Release. (August 29, 2015)

For the first time, ESC Guidelines published today give the highest degree of recommendation for the radial approach over the femoral one for coronary angiography and percutaneous coronary intervention (PCI) in patients with acute coronary syndromes (ACS).

https://escardio.org/The-ESC/Press-Office/Press-releases/Last-5-years/esc-guidelines-recommend-radial-approach-for-percutaneous-coronary-interventions-in-acs

 

 

 


 

Recommendations from the ThinkRadial Board of Advisors

We asked the ThinkRadial Board of Advisors: What is your top tip for preserving the radial artery?

Morton Kern, MD, Interventional Cardiologist, UC Irvine Medical Center

Tip to maintain better patency long term.  Multiple punctures or unsuccessful attempts to insert a sheath and a restick may produce injury, vasospasm, thrombosis or intimal hyperplasia, which may reduce patency or reaccess success.  Our lab enjoys using ultrasound radial (and femoral) artery access guidance as described in the Raust and Faust Studies to help us achieve more first stick entry and less injury to the vessel.  We have not done the follow-up study about patency yet but this is in the works.

Mladen I. Vidovich, MD, FACC, Chief of Cardiology at Jesse Brown Veterans Administration Medical Center in Chicago, Illinois

Your job is not done when you finish the procedure. The radial artery needs careful attention afterwards to prevent RAO. Our strategies are:

  • Consistent heparin anticoagulation (5000 units or 70-80U/kg)
  • Patent hemostasis
  • Rapid hemostasis device removal

We would also stress need to continuously educate “horizontally” = all cath lab staff and “vertically” = all nurses in pre-op areas and on floors/stepdown units/CCU/ICU.

Lastly, need to have “competency” training with documentation for “non-cath lab” personnel to keep your quality up.

 

 


 

Upcoming ThinkRadial Courses, workshops and events

ThinkRadial Two-Day Immersive Course – Utah, US – October 22-24, 2015

  • Interventional Cardiology Proctor: Dr. Sandeep Nathan, University of Chicago Medical Center
  • Interventional Radiology Proctor: Dr. Darren Klass, Vancouver General Hospital & UBC Hospital Vancouver, BC
    Apply for course registration!

TCT – San Francisco, October 12-14, 2015

ThinkRadial In-Booth Presentations and Learning Opportunities – Booth 2421

Monday, October 12 – 12:30-1:30pm
Dr. Richard Sola – Radial Roadblocks: How to Get Around Them
Light Lunch will be provided

Tuesday, October 13 – 12:00-1:00pm
Dr. Sandeep Nathan – Radial artery reuse:  Strategies for preserving radial artery patency
Light Lunch will be provided

Mentice Simulator and 3-D Arm with Radial Experts –Ongoing

2016 Dates for Two-Day Immersive ThinkRadial courses have been announced!

 

 


 

CALL FOR RADIAL CASES

Get direct feedback and guidance from the experts!

Do you have a challenging case or complication that you’d like to present to the ThinkRadial community? Please send it to us and we will submit it to a seasoned radial practitioner for a response and post it to the group in the next newsletter.


References

1 Kotowycz, M.A., Dzavík, V. Radial artery patency after transradial catheterization. Circ Cardiovasc Interv. 2012;5:127–133.

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