Today the Society for Cardiovascular Angiography and Interventions (SCAI) published a first-of-its-kind paper defining best practices for the use of the transradial approach for diagnosing and treating blocked heart arteries, which involves accessing the arteries via an artery in the wrist. Published online in Catheterization and Cardiovascular Interventions (CCI), the recommendations aim to ensure high-quality patient care as transradial access becomes the preferred technique for catheter-based procedures. Studies show a decreased risk for bleeding and vascular complications, increased patient satisfaction and reduced costs when the transradial approach is used.
During interventional cardiology procedures such as stopping a heart attack or testing for potential blockages (angiography), invasive/interventional cardiologists thread a slender tube (catheter) through an artery (traditionally in the upper leg) to reach the area they will treat or evaluate. Between 2007 and 2011,the use of the transradial (wrist-entry) approach for these procedures increased nearly ten-fold in the United States. As its popularity continues to increase, so does the need for best practices that equip physicians and institutions with tools and information to guide patient care.
“While there are a number of benefits to transradial over transfemoral approaches, there are risks associated with any procedure. By emphasizing proper training and highlighting best practices, we aim to ensure that patients receive the advantages of this approach while minimizing any potential complications,” said Sunil V. Rao, M.D., FSCAI, Associate Professor of Medicine at Duke University and lead author of the consensus statement.
In developing this statement, SCAI focused on three core areas to guide physicians:
- Best practices for avoiding blocked blood flow to the radial (wrist) artery
Patients should be assessed prior to discharge and at the first post-procedure visit to avoid the potential for radial artery occlusion (RAO), where blood flow to the artery is blocked. Extra care also should be taken to ensure patients receive all relevant strategies for prevention of RAO.
- Best practices for reducing potential radiation exposure to patient and operators
To reduce the risk of exposure to radiation during a transradial procedure, the patient’s accessed arm should be placed next to his or her torso, additional extension tubing should be used and operators should be cognizant of safe radiation protocols.
- Best practices for physicians transitioning to the transradial approach when treating heart attack
Studies have shown benefits when patients suffering a heart attack undergo angioplasty via the wrist. Steps must be taken to ensure physicians have mastered the technique before performing emergency cases routinely from the wrist. This learning process includes understanding when to revert to access through the femoral (groin) artery and how to ensure that using the radial approach does not result in delayed treatment or increased door-to-balloon time.
“These best practices are the latest example of our ongoing efforts to provide timely, useful resources to physicians as they care for patients,” said SCAI 2013-14 President Ted A. Bass, M.D., FSCAI. “Our commitment to quality is consistent, as is our belief that we can always do more to improve patient care.”
Download the paper, titled “Best Practices for Transradial Angiography and Intervention: A Consensus Statement from the Society for Cardiovascular Angiography and Intervention’s Transradial Working Group”.