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Transradial interventions -local perspective

Transradial interventions -local perspective. Dr Syed Nadeem Hassan Rizvi, MBBS (Pb), Dip Card (lon) , MRCP(UK), FSCAI As. Professor of Cardiology, National institute of Cardiovascular diseases, Karachi. Why Transradial ?. Early (immediate?) ambulation

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Transradial interventions -local perspective

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  1. Transradial interventions-local perspective Dr Syed Nadeem Hassan Rizvi, MBBS (Pb), Dip Card (lon) , MRCP(UK), FSCAI As. Professor of Cardiology, National institute of Cardiovascular diseases, Karachi

  2. Why Transradial ? • Early (immediate?) ambulation • Less local complications than transfemoral • Less ‘labour / staff ’ intensive

  3. Downside of transradial • Steep learning curve • Limited availability of specific radial catheters at present • Access limited upto 7F in most patients , which therefore, excludes certain techniques e.g simultaneous stenting and IABP insertion

  4. TRI-Preparation

  5. TRI-Preparation

  6. TRI-Preparation

  7. TRI-Preparation

  8. TRI-Final table setup

  9. TRI- Local anaesthetic

  10. TRI- Access

  11. TRI- Access

  12. TRI- Access

  13. TRI - Access

  14. TRI- Sheath removal

  15. TRI- Access closure / TR band

  16. TRI- Access closure / TR band

  17. TRI – TR band closure

  18. TRI- Immediate ambulation

  19. TRI- Material Easy Radial Radistop Gauze and tape/ bandage Stepty P Radstat

  20. TRI- Diagnostic catheters

  21. TRI- Guiding catheters

  22. Guide catheters Fadajet (Cordis) Muta wiseguide (BSS) Kimney Runway (BSS) Mann IMA (BSS) Radial curve (BSS)

  23. Radial / brachial anatomy

  24. JR for LCA

  25. TRI- Primary PCI

  26. TRI- Primary PCI

  27. TRI- Primary PCI

  28. TRI – Kissing balloon (6F access)

  29. TRI- bifurcation PCI

  30. TRI – bifurcation PCI

  31. TRI – Complex rescue PCI

  32. TRI – Complex rescue PCI

  33. Conclusion I • TRI is a safe and effective procedure • Has a steep learning curve and therefore needs persistence and dedication to master technique • Variety of specific hardware is limited in Pakistan mainly due to low volumes

  34. Conclusion II • Fluro times are marginally longer than femoral procedures but usually decline with increasing expertise • No specific subgroup should be exempted from this technique except those where >7F diameter access is necessary • Teaching institutes should try and adopt this technique as ‘first line’ due to its safety and cost effectiveness

  35. Thank You

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