Cannulating LIMA graft using right transradial approach: Two simple and innovative techniques

Coronary Cannulation: Tips for Success in Transradial Angiography and Interventions

Transradial artery access (TRA) is associated with reduced bleeding risk, length of stay, costs, and increased patient satisfaction. Approximately one-third of TRA failures are due to lack of guiding catheter support. Catheter selection and engagement technique are crucial for obtaining good-quality angiograms and successfully completing percutaneous coronary intervention. The maneuvers required for catheter manipulation and coronary engagement differ between TRA and transfemoral arterial access. One of the advantages of TRA is the ability to use a universal catheter, saving time, radiation, and contrast. This review discusses practical learning points to improve operator understanding of catheter selection and coronary engagement technique.

An Update on Radial Artery Access and Best Practices for Transradial Coronary Angiography and Intervention in Acute Coronary Syndrome: A Scientific Statement From the American Heart Association

Transradial artery access for percutaneous coronary intervention is associated with lower bleeding and vascular complications than transfemoral artery access, especially in patients with acute coronary syndromes. A growing body of evidence supports adoption of transradial artery access to improve acute coronary syndrome-related outcomes, to improve healthcare quality, and to reduce cost. The purpose of this scientific statement is to propose and support a "radial-first" strategy in the United States for patients with acute coronary syndromes. This document also provides an update to previously published statements on transradial artery access technique and best practices, particularly as they relate to the management of patients with acute coronary syndromes.

Transradial approach for collateral embolisation

Significant aortopulmonary collaterals in cyanotic CHD patients require closure immediately before definitive intracardiac repair. Traditionally, the transfemoral access has been used for this purpose; however in a few cases, selective and stable hooking of collaterals may be extremely difficult. We describe a case in which we used a new approach for collateral embolisation in a difficult situation.

Diagnostic and Guide Catheter Selection and Manipulation for Radial Approach

Transradial catheterization and percutaneous coronary interventions have multiple advantages, including reduced bleeding risk, reduced length of stay and costs, and increased patient comfort. Transradial catheterization and interventions requires the acquisition of various additional skill sets including radial arterial puncture, the ability to navigate the upper extremity vasculature, and understanding catheter selection and coronary engagement technique. Although standard femoral catheter shapes perform adequately from the left or right radial approach for coronary angiography, for percutaneous coronary intervention guide catheter support is critical. This article summarizes some practical learning points pertaining to navigating the upper extremity vasculature, and understanding catheter selection and coronary engagement technique.