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PREFACE |
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IN 1989, LUCIEN CAMPEAU OF CANADA PUBLISHED HIS EXPERIENCES after performing 100 coronary
angiographies through the Transradial route. In 1992, Ferdinand Kiemeneij of the Netherlands
performed the world’s first coronary angioplasty through the Transradial route. Since then,
the Transradial approach has become increasingly popular with leading coronary
interventionalists worldwide.
Our own coronary catheterization team made a total switch from the femoral to the radial
approach in late 2000 after we lost two patients due to major vascular complications of the
femoral approach. When I learned that Shigeru Saito had performed several thousand
Transradial procedures in Japan—a land where patients have relatively small radial arteries- I was inspired to start a radial program in our hospital after having performed tens of
thousands of femoral procedures.
Studies from around the world that have compared the Transradial approach to the
Transfemoral approach have shown, beyond a doubt, that major local vascular complications
with the Transradial approach are virtually nonexistent even when high-dose anticoagulation
is used.
Still, many interventionalists have shied away from the Transradial approach. This is in
spite of the fact that even minor complications are extremely rare, and that hospital staffs and
patients overwhelmingly prefer the safety, comfort, and convenience of having interventions
performed through the wrist.
This reluctance to switch to the radial approach is no doubt due to the new learning curve
which, admittedly, is relatively long and sometimes frustrating. The good news is that if our
Cath Lab can achieve so much success, yours can, too. We have now performed over 25,000
diagnostic and interventional procedures through the radial route and have encountered,
documented, and overcome 99% of the challenges.
The purpose of this Atlas is to inspire interventional cardiologists worldwide to learn as
much as possible about this elegant, staff-and-patient-friendly procedure. We hope that those who are performing 50%, 60%, or 70% of their work through the Transradial approach will be
able to increase this number to 95%. And that those who are performing fewer radial cases
will become eager to perform more.
Working with beginning and intermediate radialists from many countries, we have
discovered the best way to teach Transradial intervention and have simplified every step. In
this Atlas, you will find detailed discussions and examples of the procedure’s basics—from
the initial puncture to the cannulation of the coronary ostia.
We have not attempted to address complex intervention subsets here. These include
unprotected left main stenosis, bypass graft lesions, peripheral interventions, bifurcation
lesions, and acute myocardial infarction. We will save these for a more advanced Atlas.
If, after reading this text, you still have doubts about Transradial intervention, ask any of
the patients who has experienced both the femoral and the radial approach which approach
they preferred.
There is your answer.
Tejas Patel
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