1. 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

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

3. 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

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

6. 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% % -60% -50% -40% -30% -20% -10% % +20% +30%
relative risk transradial vs. transfemoral

7. 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

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

9. 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 PCI patients
logistic regression analysis: Increase in TRA use independently
associated with a decrese in 30-day mortaliy
odds ratio (95% confidence interval 0.66 – 0.77)

10. 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

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

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

13. 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 %
access site crossover 1 (1.6%)
vascular access site complications 3 (4.7%)
major bleeding 0
radial spasm (11%)
radial artery occlusion at 1 month 3 (4.7%)

14. outer diameter
< 6 F guide
inner diameter
like 7 F guide
Harding, Heart, Lung and Circulation 2013; 22:

16. 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 %
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

17. 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

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

19. 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 % %
access site complications 6.0 % %
procedure time 50 ± 29 min 47 ± 25 min
length of stay ± 0.6 days 2.1 ± 0.3 days

20. 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

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

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

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

24. Transradial approach for ...
... vertebrobasilar stenting

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