In response to growing U.S. interest, the Society for Coronary Angiography and Interventions recently formed a Transradial Committee whose purpose is to examine the utility, utilization, and training considerations related to transradial access for percutaneous coronary and peripheral procedures. With international partnership, the committee has composed a comprehensive overview of this subject presented herewith. © 2011 Wiley Periodicals, Inc.

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ompared with balloon angioplasty, implantation of coronary stents has significantly decreased restenosis, 1-5 but in-stent restenosis caused by neointimal hyperplasia can occur in 20-30% of cases following bare metal stent implantation [6][7][8][9][10] and clinical in-stent restenosis or ischemia-driven revascularization for significant restenosis (≥50%) occurs in 10-15% following implantation of bare metal stents. This process usually occurs within 1 year of the index procedure and is believed to have a benign presentation with recurrent angina and/or evidence of ischemia on a stress test. However, there is scant data of an acute event such as myocardial infarction (MI) presenting as clinical in-stent restenosis. We sought to determine the incidence and type of MI, as well as clinical and angiographic characteristics of patients presenting with clinical instent restenosis (namely, any recurrent ischemia occurring in the stented segment) from our single center experience. Methods Study PatientsOf 2,462 consecutive patients who underwent percutaneous coronary interventions (PCI) with bare metal stents between June 2001 and December 2002, 212 (8.6%) were found to have clinical in-stent restenosis, which was defined as angiographic stenosis >50% within 5 mm of the stented segment for patients presenting for an angiogram for clinical evidence of ischemia (viz. angina or positive stress test). Patients presenting within 30 days of index procedure, with recurrent in-stent restenosis or restenosis following balloon angioplasty only, and patients presenting with MI clearly attributable to non-restenotic lesion or vessel were excluded. The antiplatelet regimen after the initial stent deployment was aspirin 325 mg daily indefinitely, and clopidogrel 75 mg daily for 4 weeks following a loading dose of 300 mg on the day of the procedure. The average follow-up period was 205±23 days (median 124 days). Based on the presenting symptoms and findings, the patients were divided into 3 groups: ST elevation MI (STEMI), non-ST elevation MI (NSTEMI), and non-MI groups. Patients with elevation of creatinine kinase (CK) 2-fold more than the normal reference with elevated MB fraction were considered to have a MI. Patients with STEMI were to have >1 mm ST-segment elevation in ≥2 contiguous leads. The NSTEMI group had elevated cardiac enzymes as above, without ST-segment elevation on the ECG. Renal failure was defined as baseline serum creatinine >2.0 mg/dl. The angiographic pattern of instent restenosis was analyzed as classified by Mehran et al. 11 Clinical and angiographic characteristics were compared among the 3 groups. Informed consent was given by each patient and the study protocol was approval by the institutional review board. Statistical AnalysisQuantitative data are presented as mean value ±1 SD or

Background— Reducing digital pulse rates (PR) are known to reduce total energy during invasive cardiovascular procedures, which likely has benefits for patients and staff. Physicians may be reluctant to reduce these parameters because they fear a decline in image quality that could affect procedural outcomes. We sought to assess the effect of default rates of fluoroscopy (Fluoro) and CINE-acquisition (CINE) on total x-ray dose and image quality during invasive cardiovascular procedures. Methods and Results— We retrospectively reviewed procedures done with 2 default PRs: a standard dose cohort (PR, 15 for Fluoro and CINE), and a reduced dose cohort (PR, 10 for Fluoro and CINE). Total x-ray dose, Fluoro time, and contrast use were compared between groups. A blinded angiographic image quality assessment was then performed using an objective 10-point angiographic quality score. There were no significant differences between cohorts for fluoroscopy time or contrast use. The reduced dose cohort has a significant reduction in mean total x-ray dose (PR 15, 1763.1 mGy; PR 10, 1179.1 mGy; P <0.0001). When adjusted for potential confounders, a 38% reduction in total x-ray dose was identified ( P <0.0001). There was no difference in adjusted angiographic quality score between the cohorts (PR 15, 7.90; PR 10, 8.00; P =0.67), indicating no decline in image quality with PR reduction. Conclusions— Reducing default PRs during invasive cardiovascular procedures yields large and significant reductions in total x-ray energy with no decline in angiographic image quality.

RHC via the AVA is a feasible and safe alternative to PVA. Our experience and rapid adoption support the use AVA as the access site of choice for RHC in uncomplicated patients.

Left and right trans-radial approach for primary PCI have similar in room procedural times, success rates, and comparable safety. Trans-radial PCI through either arm is a feasible and safe approach in patients with STEMI.

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