Book Excerpts

Chapter 31: Discharge Instructions/Radial Lounge
Jack P. Chen, MD, FACC, FSCAI, FCCP and James Wood Tyson

There is a growing trend for outpatient discharge following percutaneous coronary intervention (PCI). The early ambulation and essential absence of access site complications associated with transradial PCI (TRI) make this approach ideal for the ambulatory strategy.

Chapter 32: Working through Arteria Lusoria: Tips & Tricks
Tejas Patel, MD, FACC, FSCAI; Sanjay Shah, MD; Samir Pancholy, MD, FACC, FSCAI

Arteria lusoria is a congenital anomaly of the right subclavian artery characterized topographically as follows: the artery originates below the left subclavian artery as the fourth main branch of the aortic arch and turns to the right behind the esophagus and in front of the vertebral column. It is an anomaly having incidence of 0.4% to 2%.

Chapter 33: Transradial CTO PCI
Rustem Dautov, MD, PhD, FRACP and Stéphane Rinfret, MD, SM, FRCPC

Chronic total occlusion (CTO) remains the final frontier of coronary interventions. There is a multitude of benefits to be gained from the CTO recanalization in a symptomatic patient or someone with CTO-attributed ischemia.

Chapter 34: Transradial Rotational Ablation
Ramon Quesada, MD, FACP, FACC, FCCP, FSAI

The use of rotational atherectomy for plaque modification in de novo complex calcified or fibrocalcific lesions began more than 30 years ago. Invented by David Auth in 1981 and approved for coronary use in 1993, it was introduced in the same era as intravascular ultrasound and coronary stents.

Chapter 35: ST-Segment Elevation Myocardial Infarction (STEMI)
Matthew Hann, MD and Sunil V. Rao, MD

Less than 10% of percutaneous coronary interventions (PCI) in the ST-segment elevation myocardial infarction (STEMI) setting are performed via the radial approach. Current data suggests that radial artery access for primary PCI is safe, feasible, and possibly offers a mortality benefit in the STEMI setting (RIVAL and RIFLE-STEACS).

Chapter 36: Transradial Interventions in Saphenous Vein Grafts
Duane S. Pinto, MD, MPH, FACC, FSCAI and Shamail S. Tariq, MD, MBA

According to the American College of Cardiology National Cardiovascular Data Registry, there were over 90,000 patients (5.7% of all PCIs) who underwent saphenous vein graft (SVG) percutaneous coronary intervention (PCI) between 2004 and 2009. Years ago, SVG PCI via the radial approach was thought to be a relative contraindication.

Chapter 37: Transradial Sheathless Approach for PCI
Douglas Fraser, MD, MB, BChir; Tawfiq Choudhury, MBBS, BSc, MRCP; Mamas A. Mamas, FRCP, DPHIL, BM BCh

The lumen of the radial artery in many patients is smaller than the outer diameter of a 6 Fr radial sheath frequently leading to procedural pain, trauma to the radial artery, and contributing to radial occlusion. Chronically, neointima formation further reduces luminal size, limiting successful re-intervention in some patients.

Chapter 38: Techniques to Increase Support
Douglas Fraser, MD, MB, BChir; Tawfiq Choudhury, MBBS, BSc, MRCP; Mamas A. Mamas, FRCP, DPHIL, BM BCh

The size of the radial artery, and the tortuous route to the coronary ostea from the radial approach, limit catheter selection for the transradial interventionalist with potential adverse consequences for backup support. This is most evident in the setting of coronary calcification and tortuosity, leading to difficulties with equipment delivery.

Chapter 39: Slender Club Japan
Takashi Matsukage, MD, PhD

After Dr. Ferdinand Kiemeneij invented transradial coronary intervention (TRI) in 1992, it gradually spread throughout the world. Recent studies have shown the possibility of less invasive percutaneous coronary intervention (PCI), and TRI has been reported to decrease bleeding complications and enable early ambulation.

Chapter 40: The Radial Approach for Renal and Mesenteric Intervention
Elizabeth M. Retzer, MD and Sandeep Nathan, MD, MSc

The benefits of the transradial approach for coronary angiography and intervention are well recognized.