SCAI expert consensus statement update on best practices for transradial angiography and intervention

Abstract

Transradial angiography and intervention continues to become increasingly common as an access site for coronary procedures. Since the first "Best Practices" paper in 2013, ongoing trials have shed further light onto the safest and most efficient methods to perform these procedures. Specifically, this document comments on the use of ultrasound to facilitate radial access, the role of ulnar artery access, the utility of non-invasive testing of collateral flow, strategies to prevent radial artery occlusion, radial access for primary PCI and topics that require further study.

SCAI position statement on optimal percutaneous coronary interventional therapy for complex coronary artery disease

“…79,81 Evidence also suggests that when necessary, femoral access may still be performed safely by expert operators using optimal ultrasound-guided access, including the use of micropuncture needles. [82][83][84][85] Multiple arterial access sites are often needed for CTO PCI or adjunctive MCS device use during complex PCI, thereby increasing the periprocedural risks of bleeding, vascular complications, and mortality. 86 These hazards may be mitigated by the use of radial or ulnar artery access as the second-access site, bilateral radial access, or single-access femoral techniques for MCS-assisted PCI.…”

Radial Artery Access

“…A recent study of high dose (100 IU/kg body weight) versus 50 IU/kg/body weight) lowered RAO [20]. That is why it has been recommended to administer at 5000 U or 50 or higher IU/kg body weight unfractionated heparin for all procedures with radial artery access [18,21]. Importance of having sheath to radial artery diameter < 1.0 is considered best for reducing RAO [18,21], pushing industry to provide sheaths with thinner walls or sheathless guide systems.…”

“…That is why it has been recommended to administer at 5000 U or 50 or higher IU/kg body weight unfractionated heparin for all procedures with radial artery access [18,21]. Importance of having sheath to radial artery diameter < 1.0 is considered best for reducing RAO [18,21], pushing industry to provide sheaths with thinner walls or sheathless guide systems. The 6.5 F sheathless Eaucath appeared to have lower RAO compared to thin walled 6F sheath, 0.0% vs. 2.0%, p 0.031 with sample size of 600 randomized patients [22]..…”

“…Maintaining radial artery patency during hemostasis is proven to reduce RAO rates, or patent hemostasis. [18,21]. This can be achieved by periodically monitoring oximetry-plethysmography after the procedure to ensure radial flow [25] Pneumatic radial compression based on the patient's mean arterial pressure and concomitant ulnar compression to increase radial flow have also been shown to be beneficial [26].…”

Impact of the Use of a Larger Forearm Artery on the Efficacy and Safety of Transradial and Transulnar Access: A Randomized Trial with Preprocedural Ultrasonography

“…It seems that in order to limit vascular complications and reduce the incidence of cramps and pain, larger RA or UA should be used. In 2019, the Society of Cardiovascular Angiography and Interventions (SCAI) recommended using preprocedural and real-time ultrasonography to facilitate forearm vascular access [10].…”