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Questions / Answers from March 15, 2011 Case

Questions / Answers

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Have you used the guide liner via the radial for difficult crossing?
Yes It will go easily just as via femoral approach with 6Fr guide catheters.
What wire is in the diagonal?
It is Fielder wire of Abbott vasc; that is the most commonly used wire for SBrs in our cath lab.
Should we use drug eluting balloon for Diagonal branch?
Yes. drug eluting balloon could be a choice, if it is available. But if there is extensive dissection, then another DES will be required.
Is this not too complex a procedure to attempt with a Trans Radial approach?
That actually was our plan to show that even though we are not the radial expert, but illustrated masterly that any lesion can safely and successfully be done via Radial approach.
If you decide to upsize the Rota Burr, can you switch to a 7 French sheath from the Trans Radial route?
Up to 1.75mm Rota burr can go thru 6Fr guide. For 2.00 and 2.25mm burrs, a 7Fr guide will be required. 7Fr guide can be inserted via radial artery in about 80% of cases; although it is needed in about 20% of PCIs (by any route).
When you fail the Right Radial, do you go to the Left Radial or go Femoral?
Once fail Rt radial our next approach is Femoral; although many interventionalists will go to Lt radial before puncturing the femoral artery.
Are you beginning to do STEMI from the Radial route?
Some cases only, about 20%; that is the overall use of Radial technique in our cath lab.
What are the cases for which you will definitely not use a Radial approach?
Our goal is to use radial approach irrespective of the lesion type; CTO, calcification, Shepard crook RCA etc.
Where are you finding the Left Radial useful?

May be in CABG cases where LIMA has been used; as it is challenging and difficult to selectively cannulate LIMA via Rt radial approach.
What are the commonest reasons you have needed to switch from Right Radial to either Left or to the Femoral approach?
The top 5 reasons to switch to femoral artery in order of frequency are; radial artery spasm, poor guide support due to non-axial guide catheter alignment, severe arm-shoulder pain during catheter manipulation despite adequate analgesia, need for 7Fr guide and radial artery too small to accommodate it.
How many cases do you think are needed for an experienced interventionalist to achieve competency in Trans Radial Interventions?
100 cases. This is supported by the literature also; after 80-100 cases failure rate of TRI decreases dramatically.
Is it a good idea to use Trans Radial approach for all consecutive procedures for a defined period of time?
YES. It is the only way you will become good at it and will not be frustrated. Once decide for TRI, just do all cases via radial approach.
Can you provide some tips for setting up a Trans Radial program?
I have covered this aspect in today's presentation. But two very important aspects are; education by attending TRI courses and commitment ; of both physician as well of the cath lab staff.
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