Minimally Invasive Cardiology for Everyone: Challenging the Transradial Access

Transradial access is now well established as the safest route for percutaneous coronary intervention. Nevertheless, its use is often restricted to “easy” cases, switch to the transfemoral route being too rapidly advocated/mandated. We will discuss the different challenges associated with a “TRA for everybody” strategy. (1) The vascular access per se is challenging. TRA failure is most of the time an operator failure to cannulate this vessel. There are some ways to overcome the technical problems and to improve the operator skill and his success rate. (2) TRA is systematically denied for some patient populations: patients with previous coronary artery bypass graft surgery are particularly at risk of not being catheterized by TRA despite excellent performance of this route for diagnostic or intervention. In the same way, MI patients in unstable condition are also at risk to be catheterized by TFA although, most of the time, their condition is addressable through TRA and will largely benefit from this route. (3) Frailty and small body-sized ill patients are also at risk of TFA for PCI when proximal coronary artery disease must be treated. There are alternatives to the use of large and very large catheters for treatment of proximal coronary artery disease. (4) The radial occlusion is a manageable problem, with simple and effective solutions

Gentleman, rebel and believer : the radial way.

The manuscript highlights some historic milestones of the universal trans-radial approach (TRA) and describes some characteristics that "radialists" share (at least in the author's opinion). The author argues against common misconceptions about the TRA, like the use of more iodine contrast, more X-ray exposition, a lower rate of successful angioplasty. Data illustrating the conversion from a trans-femoral approach catheterization laboratory to a complete TRA laboratory are presented, showing the speed of the switch and the rapid clinical benefit observed. The author concludes with possible future directions for TRA supporters, on how to optimize the material for the puncture step, how to reduce the radial occlusion rate and how to promote the TRA as the first access for acute coronary syndromes managed invasively

The Buddy Ballooning Technique- A simple debulking technique

The author describes a simple and inexpensive way to deliver high pressures within an atherosclerotic coronary artery and reports two cases. The technique used two non-compliant (NC) balloons placed in parallel and inflated together within the same coronary segment. The cases illustrate two possible indications for the technique: lesion resistant to one adequately sized NC balloon or not fully expanded coronary stents after high-pressure non-compliant ballooning.</p

Distal 'buddy-in-jail' technique: A complementary 'Jail with stent' method for stent delivery

Delivery of coronary stents can be challenging, but the use of a second or 'buddy' wire helps the progression of equipment through tortuous and rigid vessels. We successfully positioned a coronary stent in a distal lesion, intentionally jailing the buddy wire during stent delivery. The jailed wire was then used to proceed further with proximal coronary stenting. We report 10 cases using either the jailed or the non-jailed wire for this modified 'buddy-in-jail' technique. © The Author(s)

Guiding catheters for transradial approach:New designs and summary of experiences with VDL/VDR catheters. A novel score for PCI technical complexity

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