Patients with coronary artery disease frequently have comorbid conditions requiring chronic oral anticoagulant (OAC) therapy, such as atrial fibrillation, valvular heart disease, arterial or venous thromboembolic disease, or left ventricular thrombus.
Radial catheterization should not be considered a niche technique isolated to the arterial tree. The forearm is also the source of a rich supply of veins that can offer conduits for right heart catheterization.
Percutaneous Coronary Intervention (PCI) is the most commonly performed cardiac intervention in contemporary practice, with over 50% of all procedures performed in the United States.
A growing body of literature suggests that the transradial approach (TRA) for diagnostic angiography and percutaneous coronary intervention (PCI) is associated with a significantly lower cost when compared to the transfemoral approach (TFA). Recent studies suggest that total intra- and post-procedural costs of TRA diagnostic angiography and PCI are $275-$830 less when compared to TFA.
One of the major limitations to radial access is the concern for radial artery occlusion (RAO). RAO occurs in 1% to 10% of cases depending on how it is assessed. Several prior chapters have been devoted to RAO and options to prevent it. Most cases of RAO are silent and do not cause the patient harm or discomfort.
Radial artery (RA) access provides multiple advantages over other access options for catheterization procedures as described earlier in this book. These advantages are offset by a relatively frequent occurrence of radial artery spasm (RAS), which can turn this elegant, patient-friendly procedure into a painful, tedious, and rarely impossible procedure.
History of the Bartorelli-Cozzi catheter
There are several universal guiding catheters that can be engaged both for left and right coronary arteries. What is the benefit of a universal guiding catheter? First, it can reduce cost in case of PCI for both left and right coronary arteries. Second, it can reduce time by avoiding catheter exchange.
Transradial (TR) access for percutaneous coronary procedures reduces vascular complications and bleeding, and thus improves clinical outcomes compared to the transfemoral (TF) approach. Yet, radial access is underutilized in clinical practice in many countries including the United States.
The transradial approach for management of hemodynamically unstable patients has been termed the “final frontier” of the radial approach. Even experienced radial operators continue to use the femoral approach in ST elevation myocardial infarction (STEMI) complicated by cardiogenic shock. In general, physicians site two reasons for preferring the femoral approach in STEMI patients with shock.