1. Radial Artery Access: Procedural Considerations
Samir B. Pancholy, MD, FACP, FACC, FSCAI
Program Director, Fellowship in Cardiovascular Diseases, The Wright Center for Graduate Medical Education, Associate Professor of Medicine, The Commonwealth Medical College, Scranton, PA.

2. Honoraria: Medtronic, Inc. Terumo Cardiovascular Systems Group
Samir B. Pancholy, MD
Honoraria:
Medtronic, Inc.
Terumo Cardiovascular Systems Group

3. Agenda
Access
Catheters
Hemostasis

4. Radial artery puncture
Smaller lumen, thicker arterial wall
Superficial
Muscular wall, spasm prone

5. Radial artery puncture
Smaller lumen use smaller caliber needle smaller caliber more flexible guidewire (0.018” or 0.021”)

6. Hydrophilic Sheath

7. Radial artery puncture
Anterior puncture technique Commonly used for femoral / brachial puncture
Requires more skill

8. Radial artery puncture
Counter puncture technique through and through puncture transfixation of the vessel controlled entry into the lumen teflon-sheathed needle (coaxialization)

9. Counter puncture technique

10. Radial artery puncture
Comparison of two techniques

11. RATE Trial
Pancholy S et al. Catheter Cardiovasc Interv Aug 1;80(2):288-91

12. RATE Trial
Pancholy S et al. Catheter Cardiovasc Interv Aug 1;80(2):288-91

13. Thicker walled artery
Large media, muscular, rich in alpha-1 receptors – more spasm
Smaller lumen – stasis – thrombus - occlusion

14. Cocktail
Spasmolytic – nitrates + calcium blocker

15. Spasmolytics Nitrates – rapid onset and offset, short acting
Calcium blocker – slower onset and offset, longer acting
Administer intra-arterially

16. Anticoagulation
Essential in RAO prevention

17. Anticoagulation is essential
Spaulding C et al. Cathet Cardiovasc Diagn Dec;39(4):

18. Route of administration does not matter
Pancholy S. Am J Cardiol Oct 15;104(8):1083-5

19. Access summary Use lower profile needle Lower profile guidewire
Counter puncture technique
Spasmolytic cocktail
Anticoagulation (a class effect)

20. Catheters Femoral catheters LRA similar to femoral
RRA: LCA catheter 0.5 size smaller RCA catheters same as TFA

21. Catheters
Universal catheters: Tiger / Jacky / Sarah Kimny / MAC / PAPA
Unique “learning curve”

22. Hemostasis
Radial artery compression well tolerated base formed by radius macro / micro collateralization no nerve or other structures

23. Hemostasis
Related to RAO Patent hemostasis

24. PROPHET Trial
Pancholy S et al. Catheter Cardiovasc Interv. 2008;72(3):

25. Patent Hemostasis

26. Summary Radial artery NOT a small femoral artery
Use dedicated equipment/techniques
“Best Practices”

27. Thank you