TRIP: Radial Access and Beyond - PowerPoint Presentation

Slide1

TRIP: Radial Access and BeyondSCAI Update on Transradial Angiography and Intervention Best Practices

Adhir Shroff, MD, MPH

Associate Professor of Medicine

University of Illinois – Chicago

Jesse Brown VA Medical Center

arshroff@uic.edu

@ARS_MD2004

#

RadialFirst

Disclosure Statement of Financial Interest

Consulting Fees/Honoraria/Speakers Bureau:

Terumo

Cordis

AbiomedMedtronicEquity Interests: NoneRoyalty Income/Intellectual Property Rights: NoneSalary/Salary Support/Employee: None

Within the past 12 months, I have had a financial interest/arrangement or affiliation with the organization(s) listed below.

Catheter Cardiovasc Interv. 2020 Feb;95(2):245-252

TR Best Practices

Topics covered based on quality of evidence to guide a specific practice

Ultrasound guidance for TRA

Ulnar artery accessUtility of routine, non-invasive assessment of collateral flowUpdate on RAO prevention

TRA for primary PCIFuture studyOptimal anticoagulation strategyDistal radial accessHand dysfunctionUse of the radial artery as a future conduitCatheter Cardiovasc Interv. 2020 Feb;95(2):245-252

Ultrasound guidance for TRA - Recommendations

Operators should develop proficiency with ultrasound guidance

Real-time ultrasound guidance should be used when difficulty with radial access is encountered or expected

Catheter Cardiovasc Interv. 2020 Feb;95(2):245-252

RAUST

JACC Cardiovasc Interv.

 2015 Feb;8(2):283-291

Ulnar Artery Access - Recommendations

Radial artery is preferred over ulnar artery in most situations

UA is a reasonable alternate site when risks RA complications are high

Ipsilateral UA is reasonable secondary access site after failed radial accessIn cases of known RAO, insufficient data to provide a recommendation for ipsilateral UA access over contralateral RA or TFA

Catheter Cardiovasc Interv. 2020 Feb;95(2):245-252

Ulnar Artery Studies

Catheter Cardiovasc Interv. 2020 Feb;95(2):245-252

Utility of routine, non-invasive assessment of collateral flow - Recommendations

TR catheterization can be performed safely regardless of results of non-invasive testing. Routine collateral testing should NOT be used as a triage tool for access site selection

Collateral testing may be useful for assessment of RAO post-procedure

Catheter Cardiovasc Interv. 2020 Feb;95(2):245-252

RADAR

Am Heart J 2004;147:489–93.

J Am Coll

Cardiol

2014;63:1833–41

Update on RAO prevention -Recommendations

Updated or New recommendations

IV or IA UFH 5,000u or 50u/kg or a

higher

dose is recommendedConcomitant ipsilateral UA compression is recommendedContinued recommendationsLowest profile sheath and/or catheter systemPatent hemostasis should be the default strategyCatheter Cardiovasc Interv. 2020 Feb;95(2):245-252

New RAO Studies

SPIRIT of ARTEMIS:

100u/kg vs 50 u/kg UFH

PROPHET II: Routine ulnar compression

JACC Cardiovasc Interv. 2018 Nov 26;11(22):2241-2250JACC Cardiovasc Interv. 2016 Oct 10;9(19):1992-1999

TRA for Primary PCI - Recommendations

TRA can (should) be used for primary PCI to reduce vascular complications and bleeding

Operators should be experienced with non-emergent TR-PCI

Defined strategies for arterial access site cross-over must be in place

Catheter Cardiovasc Interv. 2020 Feb;95(2):245-252

MATRIX

European Heart Journal (2017) 38, 1069–1080

Take Home Points

Transradial practice has developed rapidly over the past 10 years

Best Practice Statements hope to integrate clinical data into recommendations on practice

Improve adoption of proven techniques and practices (contrary is true as well)Decrease practice variationImprove outcomes

Questions?????

Thank you.

arshroff@uic.edu

@ARS_MD2004

312-485-4511