What´s New in the Literature on Transradial Intervention Wolfgang Schöls Duisburg Heart Center Department of Cardiology, Angiology and Electrophysiology Department of Pediatric Cardiology and Congenital Heart Disease Department of Cardiac Surgery

What´s not quite new.... ....but quite nice anyway

Radial versus femoral access for coronary angiography or intervention and the impact on major bleeding and ischemic events: A systematic review and meta-analysis of randomized trials Jolly SS et al., Am Heart J 2009 less major bleedings trend towards reduced incidence of death, MI or stroke

What´s new in the literature.... ....regarding indications for transradial interventions

Transradial vs Transfemoral Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction: A Systematic Review and Meta-analysis Singh S et al., Can J Cardiol 2016 Meta-analysis of 16 randomized controlled trials comprising data from 9726 patients all-cause mortality major bleeding access site bleeding major adverse cardiovascular events stroke * * * * n. s. -90% -80% - 70% -60% -50% -40% -30% -20% -10% 0 +10% +20% +30% relative risk transradial vs. transfemoral

Transradial vs transfemoral approach for percutaneous coronary intervention in cardiogenic shock: A radial-first centre experience and meta-analysis of published studies Roule V et al., Arch Cardiovasc Dis 2015

death RR 63% major bleeding RR 44% transfusions RR 57%

Changes in Arterial Access Site and Association With Mortality in the United Kingdom: Observations from a National Percutaneous Coronary Intervention Database Mamas MA et al., Circulation 2016 2005 – 2012: Increase in TRA use from 14% to 58.6% in 417 038 PCI patients logistic regression analysis: Increase in TRA use independently associated with a decrese in 30-day mortaliy odds ratio 0.70 (95% confidence interval 0.66 – 0.77)

Transradial versus transfemoral rotablation for heavily calcified coronary lesions in contemporary drug-eluting stent Era Yin WH et al., J Geriatr Cardiol 2015 6 F 59%; 7 F 31%,; 8 F 10% 126 consecutive patients with heavily calcified coronary lesions 59 transradial Rotablation PTCA DES-Implantation in 90% 67 transfemoral 6 F 10%; 7 F 78%, 8 F 12% transradial transfemoral procedural success rate 97% 99% death, myocardial infarction 4% 7% major access site bleeding 2% 16% * length of hospital stay 5.1±16,5 days 9.2±20.6 days

What´s new in the literature.... ....regarding technical developments

Size of the radial artery 2.6 ± 0.4 (1.2 – 4.0) mm (Yoo et al. 2005)

First prospective multicenter experience with the 7 French Glidesheath Slender for complex transradial coronary interventions Aminian A et al., Catheter Cardiovasc Interv 2016 Prospective multicenter registry of complex TR PCI cases in 60 patients distal left main stenosis (n = 20) complex bifurcation lesions (n = 16) chronic total occlusions (n = 15) lesions requiring rotablation (n = 10) procedural success 97% access site crossover 1 (1.6%) vascular access site complications 3 (4.7%) major bleeding 0 radial spasm 7 (11%) radial artery occlusion at 1 month 3 (4.7%)

outer diameter < 6 F guide inner diameter like 7 F guide Harding, Heart, Lung and Circulation 2013; 22: 188-192

Effectiveness and Safety of the Transradial 8 Fr Sheathless Approach for Revascularization of Chronic Total Occlusions Dautov R et al., Am J Cardiol 2016 sheathless transradial technique with regular 8 Fr catheters applied in 119 patients biradial approach (8 F side and 6 F side) used in 28 patients (24%) 119 Technical success rate 93% No major vascular or bleeding complications Grade III radial hematomas 4 (3%) No increase in procedure time, contrast use, radiation dose Doppler follow-up 3 – 6 months post procedure in biradial patients, Radial artery occlusions: 8 Fr side 2, 6 Fr side 1

George S, Mamas MA, Nolan J, Ratib K Radial artery perforation treated with balloon tracking and guide catheter tamponade - A case series George S, Mamas MA, Nolan J, Ratib K Cardiovasc Revasc Med 2016

What´s new in the literature.... ....regarding non-coronary interventions

Comparison of Transradial vs Transfemoral Access for Aortoiliac and Femoropopliteal Interventions: A Single-Center Experience Roy AK et al., J Endovasc Ther 2016 188 patients with lower limb claudication or critical limb ischema aortoiliac (62%) or femoropopliteal (38%) interventions on 210 lesions transfemoral access 65% transradial access 35% transfemoral transradial crossover rate 7.3 % 16.9 % access site complications 6.0 % 3.7 % procedure time 50 ± 29 min 47 ± 25 min length of stay 2.2 ± 0.6 days 2.1 ± 0.3 days

Transradial Approach for Noncoronary Interventions: A Single-Center Review of Safety and Feasibility in the First 1,500 Cases Posham R et al., J Vasc Interv Radiol 2016 Transradial Access for Visceral Endovascular Interventions in Morbidly Obese Patients: Safety and feasibility Biederman DM et al., J Vasc Access 2016 Transradial and Transfemoral Percutaneous Closure of Iatrogenic Perimembraneous Ventricular Septal Defects Using the Amplatzer AVP IV Device Weeraman D et al., International J Cardiol 2016

Transradial approach for ... ... renal artery stenting

Transradial approach for ... ... subclavian artery stenting

Transradial approach for ... ... carotid artery stenting

Transradial approach for ... ... vertebrobasilar stenting

Transradial approach for ... ... urbi et orbi