Book Excerpts

Chapter 1: Patient Preparation: Right Radial Access
Bernadette Speiser, MSN, CCRN, RCIS

The preparation for a radial catheterization should first focus on the education of the patient for the invasive procedure. The patient may misleadingly believe that he or she is having a “surgical” procedure and not a percutaneous stick with an outpatient stay.

Chapter 2: Patient Preparation: Left Radial Access Setup in the Cath Lab
Alessandro Sciahbasi, MD

The left radial approach is an important alternative to standard right radial access with significant advantages, especially in specific settings of the population (i.e., patients with previous coronary artery bypass or aged patients). However, many physicians do not appreciate the left radial access because of a remarkable discomfort that is more pronounced at the back level. When performing a

Chapter 3: Radiation Exposure and Protection: The Radial Approach
Mladen I. Vidovich, MD, FACC, FSCAI

Radial cardiac catheterization and intervention has been increasing steadily worldwide due to its unique advantages associated with lower bleeding complications, decreased mortality in STEMI, lower cost, and overall greater patient satisfaction and preferences.

Chapter 4: Dual Circulation Assessment
Ian C. Gilchrist, Sr., MD, FACC, FSCAI

The quintessential characteristic of the forearm that makes transradial catheterization so safe and forgiving is the presence of abundant and redundant vascular supply. The robust vascular supply of the hand has impressed generations of physicians and has provided a readily available example of collateral circulation to demonstrate to healthcare and physiology students.

Chapter 5: Ultrasound Access for Transradial Catheterization
Arnold H. Seto, MD, MPA and Zoran Lasic, MD

The first and, at times, most challenging step in transradial catheterization is vascular access. Although superficial, the radial artery is small, averaging 2.4 mm to 2.6 mm in diameter, compared with 7 mm for the femoral artery.

Chapter 6: Contraindications to Radial Artery Access
Alice A. Perlowski, MD, FACC, FSCAI and Morton Kern, MD, FACC, MSCAI, FAHA

The radial artery is considered a superior access site for percutaneous coronary and peripheral interventions due to its easy compressibility, low bleeding complication rate, and association with reduced mortality in high-risk patient populations.

Chapter 7: Shoulder Anatomy
Pinak B. Shah, MD

A detailed understanding of the arterial anatomy of the shoulder and potential anatomical variations is paramount to building a successful radial catheterization experience. In the majority of patients, the shoulder anatomy is straightforward whether approaching the ascending aorta from the right radial artery or left radial artery.

Chapter 8: Aortic Anatomy
Vikas Singh, MD and Mauricio G. Cohen, MD, FACC, FSCAI

Aortic anatomy plays a vital role in success of transradial (TR) procedures. The progressively increasing success rate achieved with TR procedures is related directly to the knowledge of possible anatomic obstacles and the appropriate techniques to overcome them.

Chapter 9: Anticoagulation
Daniel Feldman, MD and Adhir Shroff, MD, MPH

Similar to transfemoral percutaneous coronary interventions (PCI), anticoagulation is indicated during transradial PCI in order to minimize the risk of acute coronary thrombosis.

Chapter 10: Left vs. Right Radial Access
Alessandro Sciahbasi, MD

While operators can perform transradial access by using both the right and left radial access, most prefer the right approach mainly for two reasons: it is similar to the transfemoral approach and it is more comfortable for the operator.