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Transradial Angiography: Coming to a Consensus

Transradial Angiography: Coming to a Consensus

Research indicates that the adoption of transradial angiography increased 10-fold between 2007 and 2011 in the United States. Randomized and observational studies have suggested that radial access reduces bleeding and vascular complication risks. Other studies have shown the approach reduces costs, increases patient satisfaction, and reduces mortality in some high-risk patients. 3 Major Recommendations To provide a guide to operators who are early in their adoption of radial procedures or are contemplating adoption, the Society for Cardiovascular Angiography and Intervention (SCAI) published a consensus statement in Catheterization and Cardiovascular Interventions. The document issued three major recommendations: 1. Preserve the radial artery and utilize practices that preserve radial artery patency. 2. Minimize patient and operator radiation exposure during radial procedures. 3. Transradial primary PCI for patients with STEMI should be performed only after sufficient experience is achieved in elective cases. “To monitor for and reduce the risk of radial artery occlusion, we recommend using adequate anticoagulation, the smallest profile equipment possible to minimize trauma to the radial artery and still obtain high-quality images, and non-occlusive hemostasis at the end of the procedure,” says Sunil V. Rao, MD, FSCAI, who served as lead author of the SCAI consensus statement (Table 1). “It’s important to keep enough pressure on the radial artery to obtain hemostasis but not so much that the antegrade flow is prevented.” The consensus statement also recommends that operators monitor for radial artery occlusions immediately after a radial procedure and during follow-up. SCAI recommends using ultrasound Doppler measurements or the reverse Barbeau test to accomplish this task. Radiation: Operator Considerations SCAI has published much information on reducing patient and...
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