TRI Manual

Preface



Publishing TRI-manual
Since first transradial approach was introduced 17 years ago, recently this approach rapidly has become widespread
throughout the world and the major approach for coronary angiography and intervention especially in Europe and Asia.
About half of hospitals in Korea use a radial artery as primary route of coronary angiogram and intervention. As
comparing to transfemoral approach, the transradial approach gain similar procedural success rate but reduces access
site related bleeding complications and increases patient comfort for early ambulation. Disadvantage of the transradial
approach is the learning curve for puncture, catheter manipulation, and not familial anatomical variation. A radial
artery has also some limitations as routine approach in complex lesion subset. But operator’s experience and
development of miniaturizes special equipment like as 5Fr Guiding catheter, sheathless guiding catheter, strong backup
forced guiding catheter, tapering guide wire and 010” balloon and wire system can overcome some limitations.
Recently published mata-anaylysis of 23 randomized trials showed that there were similar hard and soft endpoint between
transradial and transfemoral approach, but there was significant heterogeneity. That means expert experience is the
important factor of outcome benefits
I hope this book will be helpful to overcome the learning curve, especially beginner.
Even though very busy schedule, all editors made an effort to this manual.
I appreciate all editors in this book as a representative of transradial intervention workin group(TRIWG).


Chairmen of TRI Working Group: Keum Soo Park MD., Ph.D.
1 History of transradial angiography and intervention 1
2 Patient selection for Transradial intervention 9
3 Preparation for transradial approach … 15
4 Radial artery access 23
5 Catheter Selection of Transradial Coronary Angiogram 29
6 Guiding catheter selection of transradial coronary intervention 37
7 Overcome the tortuosity from radial artery to subclavian artery-Tips and Tricks 45
8 Comparison of transradial approach and transfemoral approach 53
9 Hemostasis of arterial access site 59
10 Transradial Intervention of Bifurcation Lesion 67
11 Percutaneous Transradial Coronary Intervention for Chronic Total Occlusion 73
12 Management of calcified lesions 81
13 Transradial primary percutaneous coronary intervention of STEMI 89
14 Transradial Diagnosis and Intervention of Supraaortic Arterial Disease 97
15 Transradial Peripheral Intervention and Angiography 105
16 Review of complicated cases in transradial procedure 115
Case 1
Overcoming the small and tortuous radial artery by using 0.014 inch PTCA guide-wire 117
Case 2
Transradial diagnostic approach through the accessory artery to overcome the radial alpha loop using 4 Fr diagnostic
catheter 121
Case 3
Spontaneous resolution of left brachial artery rupture 123
Case 4
Left radial artery dissection during sheath insertion 127
Case 5
Sheathless catheter is a useful device when radial artery spasm is developed in the transradial intervention 129
Case 6
Feasibility of sheathless guiding catheter in case of high origin of radial artery 133
Case 7
Feasibility of transradial intervention of AMI in the old-aged patient 137
Case 8
Successful Recanalization of Chronic Total Occlusion of the Superior Mesenteric Artery through the Left Radial artery
141
Case 9
A case of transradial coronary intervention at bifurcation between posterior descending and posterior lateral branch
of right coronary artery by using mini-crushing technique 145
Case 10
A case of stenting at ostial lesion of right internal mammary artery graft 149
Case 11
PCI of chronic total occlusion using 5 Fr guiding system 153