Dr. Carlo Trani,
I had the chance to co-chair with Dr L. Gao from Bejing the session on “Transradial Coronary Interventions” . It was a very interesting session covering several aspects of radial access applied to coronary interventions, from both scientific and technical ground. In the first talk, Dr G. Stankovic did an excellent overview on how to treat left main and bifurcations lesions. All the techniques have been shown, with special attention to their compatibility with the 6 Fr catheters that are the standard in radial practice. The main message of this talk is that the vast majority of such complex lesions can be treated by a radial approach. However, there still exist situations in which, due to the need for larger catheters, the femoral approach might be preferable. During the discussion, new guiding catheters have been discussed as a solution, but it was emphasized that these devices need a learning curve to overcome the difficulties in manipulations and potential danger. The second lecture was done by Dr Y. Ikari who talked about when to go transradial in Chronic Total Occlusions (CTOs). From the Japanese experience, the first selection criterion is based on the occlusion morphology and the “J-CTO score” has been proposed and can be helpful in selecting easier lesions. Dr Ikari identified the need for strong backup and the difficulty in crossing the occlusion with the wire as the two major problems during PCI for CTOs. Dedicated guiding catheter’s curves can solve the first problem while the use of “slender” technique (i.e. tapered or 0.010” wires) is a good solution to increase the ability to cross the occlusion. An intriguing suggestion emerged during the discussion, namely the possibility of a simultaneous double approach with two operators working independently in the same patient, one from a femoral and the other from a radial access, to spare time, x-ray exposure and contrast. In the third lecture, Dr P. Garot discussed the topic of ad-hoc and outpatient angioplasty. The feasibility and safety of outpatient PCI in selected patients has been demonstrated in several registries and trials over the last years. The results are very encouraging since they show a reduction in hospital costs, great appeal for the patients without any increase in complications and risks. However, the widespread application of an outpatient strategy, although implemented with good results in a few dedicated centres, is actually hampered by reimbursement issues in the majority of countries. In the last presentation, Dr. V. Velchev spoke on complication management. First of all, he pointed out that complications of the radial approach are rare but exist nonetheless, and that they can be threatening. The most important point is that the best way to deal with a radial complication is to do as much as possible to prevent them and, once they occur, to identify them as soon as possible. As a general rule, even nasty situations like perforations and ruptures, if promptly recognized, can be easily solved on the table by internal or external compression. The main take-home message is never force against resistance, and perform radial angiography in case of any difficulties in device advancement. In conclusion, the session was very interesting with a good mix of scientific data and practical aspects. The interaction with the audience was satisfactory and I think that we reached the objective of combining update and teaching.
Transradial coronary interventions
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