Institut Cardiovasculaire Paris Sud Radial Access: state of the art n Y. Louvard n Massy, France.

IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud

Radial Access: state of the artRadial Access: state of the art

Y. LouvardY. Louvard Massy, FranceMassy, France


Radial Access: state ofRadial Access: state ofthethe artart

Y. Y. LouvardLouvard

Massy, FranceMassy, France11th Kamakura Live11th Kamakura Live DemonstrationDemonstration


Transradial approach: the best way Transradial approach: the best way to reduce the vascular complication to reduce the vascular complication rate and the cost, and to improve rate and the cost, and to improve

patient comfortpatient comfort

II nstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud

Transradial approachTransradial approach:: thethe bestbest waywaytoto reduce the vascularreduce the vascular complication complication raterate and the costand the cost, , andand toto improveimprove

patient patient comfortcomfort


E-SI RI US: Success MeasuresEE--SI RI US:SI RI US: Success MeasuresSuccess Measures

Device Success 171 (100% ) 171 (99.4% )

Lesion Success 171 (100% ) 172 (100% )

Procedure Success 167 (97.7% ) 169 (98.3% )

Major Bleeding 6 (3.4% ) 4 (2.3% )

Major Vasc. Compl. 4 (2.3% ) 4 (2.3% )

Device SuccesDevice Success s 171 (171 (100%100% )) 171 (171 (99.4%99.4% ))

Lesion SuccessLesion Success 171 (171 (100%100% )) 172 (172 (100%100% ))

Procedure SuccessProcedure Success 167 (167 (97.797.7%% )) 169 (169 (98.3%98.3% ))

Major BleedingMajor Bleeding 6 (6 (3.4%3.4% )) 4 (4 (2.3%2.3% ))

Major Vasc. Compl.Major Vasc. Compl. 4 (4 (2.3%2.3% )) 4 (4 (2.3%2.3% ))

ControlControl(n (n == 172)172)

SirolimusSirolimus(n (n == 171)171)


Impact of Access Site Hematoma Impact of Access Site Hematoma With Transfusion in Patients With Transfusion in Patients

Undergoing PCIUndergoing PCI

6613 PCI (98-00)(NHLBI): hematoma w transfusion 1.8% (97% 6613 PCI (98-00)(NHLBI): hematoma w transfusion 1.8% (97% femoral)femoral)

Independent predictors: Older age, female, thrombotic lesion, Independent predictors: Older age, female, thrombotic lesion, 3-VD, renal disease, emergent PCI, prior aspirin3-VD, renal disease, emergent PCI, prior aspirin

HWT no HWT pHWT no HWT p

Procedural death (%): 10.3 1.2 <0.001Procedural death (%): 10.3 1.2 <0.001

death/MI (%): 18.1 3.55 <0.001 death/MI (%): 18.1 3.55 <0.001

HWT is a predictor of death/MI (OR = 3.49; 95% CI: 1.98-6.14)HWT is a predictor of death/MI (OR = 3.49; 95% CI: 1.98-6.14)

J. Slater Am J Cardiol 2003 (suppl) 92: J. Slater Am J Cardiol 2003 (suppl) 92: 18L 18L


Clinical Significance of Bleeding Clinical Significance of Bleeding ComplicationsComplications

From Blankenship Am Heart J 1999; 138: S287-S296From Blankenship Am Heart J 1999; 138: S287-S296

Median Length Median Length of Hospital Stay of Hospital Stay

(Day)(Day)

Extra Extra CostCost OthersOthers

Any Vascular Site Any Vascular Site Bleeding / Vascular Bleeding / Vascular ComplicationComplication

+ 1+ 1Incapacitation (days-Incapacitation (days-weeks)weeks)

Return to normal Return to normal activity delayactivity delay

Major or Minor Major or Minor Vascular Site Bleeding Vascular Site Bleeding / Vascular / Vascular ComplicationComplication

+ 2+ 2 + 1327 $+ 1327 $ --

Major Vascular Site Major Vascular Site Bleeding / Vascular Bleeding / Vascular Complication Complication (Surgical)(Surgical)

+ 4+ 4 + 5896 $+ 5896 $ --


Radial / Femoral Approach meta-Radial / Femoral Approach meta-analysis: Entry site complications analysis: Entry site complications

Agostini P personal communicationAgostini P personal communication


Transradial approach: for Transradial approach: for PCI, for Diagnosis, for PCI, for Diagnosis, for

Both?Both?


Transradial approachTransradial approach: for PCI , : for PCI , for for DiagnosisDiagnosis, for , for BothBoth??


ACCESS StudyACCESS Study

RadialRadial Brachial Femoral p Brachial Femoral p

Approach failure (%)Approach failure (%) 7 7 4.3 0.3 <0.001 4.3 0.3 <0.001

Procedural success (%) 91.7Procedural success (%) 91.7 90.7 90.7 90.7 90.7 NS NS

Equipment:Equipment:

Guiding cath. (n) 1.3Guiding cath. (n) 1.3 1.3 1.3 1.3 1.3 NS NS

Balloons (n)Balloons (n) 1.3 1.3 1.3 1.3 1.3 1.3 NS NS

Stenting (%)Stenting (%) 4.7 4.7 7 4.7 7 4.7 NS NS

Procedural time (Min) 40Procedural time (Min) 40++2424 39 39++25 3825 38++2424 NS NS

Fluoro. Time (Min 13Fluoro. Time (Min 13++1111 12 12++10 1110 11++10 0.0610 0.06

Hospital stay (days) 1.5Hospital stay (days) 1.5++2.52.5 1.8 1.8++3.8 1.83.8 1.8++4.24.2 NS NS

Kiemeneij JACC 1997;29:1269-75Kiemeneij JACC 1997;29:1269-75


Radial Artery Diameter (Ultrasound)Radial Artery Diameter (Ultrasound)n=120n=120

0

10

20

30

40

50

<2,1mm 2,1-2,4mm 2,5-2,7mm 2,8-3,1mm >3,1mm

2,92,9++0,6 mm0,6 mm

5f 6f 7f 8f5f 6f 7f 8f

Y. LouvardY. Louvard unpublishedunpublished


Catheters / DevicesCatheters / Devices / Technique Compatibility / Technique Compatibility

Catheter SizeCatheter Size DevicesDevices TechniquesTechniques Radial Radial CompatibilityCompatibility

5f5f Balloons Balloons << 5 mm 5 mm

Stents Stents << 4.5 mm 4.5 mm

IvusIvus

Rota 1.25 mmRota 1.25 mm

No Kissing BalloonNo Kissing Balloon

100%100%

6f6f All Coronary balloonsAll Coronary balloons

All Coronary stentsAll Coronary stents

Cutting BalloonCutting Balloon

Rota Rota << 1.75 mm 1.75 mm

Protection device Protection device (EPI…)(EPI…)

Kissing BalloonKissing Balloon

86.9%86.9%

7f7f AngioguardAngioguard

Rota 2 mmRota 2 mmKissing StentKissing Stent 76.9%76.9%

8f8f PercusurgePercusurge

SimpsonSimpson

Rota >2 mmRota >2 mm

64.7%64.7%


A randomized trial of 5 vs. 6 French A randomized trial of 5 vs. 6 French transradial percutaneous coronary transradial percutaneous coronary

interventionsinterventions

5 Fr / 6 Fr guiding catheter, 171 pts with coronary lesions 5 Fr / 6 Fr guiding catheter, 171 pts with coronary lesions suitable for 5 Fr transradial approachsuitable for 5 Fr transradial approach

5 Fr 6 Fr p5 Fr 6 Fr p

Procedural success (%) 95.4 92.9Procedural success (%) 95.4 92.9Cor. cannulation failure (%) 1.1 4.8 0.08 Cor. cannulation failure (%) 1.1 4.8 0.08 Minor hematomas (%) 1.1 4.8 0.07Minor hematomas (%) 1.1 4.8 0.07Loss of radial pulse (%) 1.1 5.9 0.05Loss of radial pulse (%) 1.1 5.9 0.05

Dahm JB CCVI 2002; 57(2):172-6


CARAFE (Technical CARAFE (Technical Data)Data)

Femoral Right RadialFemoral Right Radial Left Left

RadialRadial

N= 70 70 70

Cross overCross over 0 0 1 (1.4%)* 1 (1.4%)* 0 0

LCA catheter (n)LCA catheter (n) 1.1 1.1++0.30.3 1.2 1.2++0.60.6

1.11.1++0.30.3

RCA catheter (n)RCA catheter (n) 1.0 1.0++0.20.2 1.1 1.1++0.30.3

1.01.0++0.20.2

Total catheters (n)Total catheters (n) 2.1 2.1++0.40.4 1.4 1.4++0.7** 0.7**

2.12.1++0.40.4

* p=ns : L Rad , ** p<.000 vs Femoral and L * p=ns : L Rad , ** p<.000 vs Femoral and L RadRad

Y. Louvard CCVI 2001; 52: 181-Y. Louvard CCVI 2001; 52: 181-187187


Looking for the best multipurpose Looking for the best multipurpose catheter for Right transradial coronary catheter for Right transradial coronary

angiographyangiography

Multipurpose (too much rotation)Multipurpose (too much rotation)

Amplatz AL2 (AL1)Amplatz AL2 (AL1)

Champ (dead…)Champ (dead…)

JL 3.5 (for left and right!)JL 3.5 (for left and right!)

Tiger II +++Tiger II +++


Transradial Approach Reduces Bleeding Transradial Approach Reduces Bleeding Complications and Length of Stay in Patients With Complications and Length of Stay in Patients With

GP IIb/IIIa InhibitorsGP IIb/IIIa Inhibitors

G. Revtyak Am J Cardiol 2001; 88: 39G

*p <0.05, major bleeding (TIMI criteria), major (requiring surgical repair), and minor (pseudoaneurysm or charted hematoma) access site complications

FA RA p valueN= 2432 164GPIIbIIIa – (%) 61 90Major bleeding (n) 164 0 <0.05Major complication (n) 21 0 <0.05Minor complication (n) 59 6 <0.05Thrombocytopenia (n) 17 3 <0.05Length of stay (hrs) 70.6 36.6 <0.05


Transradial vs. transfemoral approach in Transradial vs. transfemoral approach in primary stent implantation for patients with primary stent implantation for patients with acute myocardial infarction: TEMPURA trialacute myocardial infarction: TEMPURA trial

149 pts with AMI 149 pts with AMI << 12 hr, randomized into 2 groups 12 hr, randomized into 2 groups

TRI TFI TRI TFI

N= 77 72 N= 77 72

Cross over (n) 1 0Cross over (n) 1 0

Severe bleeding complication (n) 0 2Severe bleeding complication (n) 0 2

Success of reperfusion (%) 96.1 Success of reperfusion (%) 96.1 97.197.1

in-hospital MACE (%) 5.2 8.3in-hospital MACE (%) 5.2 8.3

Saito CCVI 2003; 59(1):26-33


OCTOPLUS: Primary OCTOPLUS: Primary endpoint, Intention to treat endpoint, Intention to treat

analysisanalysisFemoralFemoral RadialRadial p p

valuevalue

n=n= 185185 192192

Vasc. Surgery (%)Vasc. Surgery (%) 00 0.50.5 nsns

Transfusion (%)Transfusion (%) 1.61.6 1.01.0 nsns

Hb drop > 3g/DL (%)Hb drop > 3g/DL (%) 3.83.8 0.50.5 0.0630.063

False aneurysm compression (%)False aneurysm compression (%) 1.11.1 0.50.5 nsns

Arm or leg ischemia (%)Arm or leg ischemia (%) 00 00 nsns

Forearm compartment syndrom Forearm compartment syndrom (%)(%)

00 00 nsns

Large hematoma* (%)Large hematoma* (%) 6.56.5 1.61.6 0.0310.031

COMPOSITE END-POINT $ (%)COMPOSITE END-POINT $ (%) 6.56.5 1.61.6 0.0290.029

Hematoma (%)Hematoma (%) 11.411.4 3.53.5 0.0030.003

CVA (%)CVA (%) 0.60.6 00 NsNs$ surgery, transfusion, Hb loss>3g/100ml-Ht loss>10%, ischemia, FA, vasc. Complic. leading to discharge delay *Large hematoma: discharge delay


Safety of same-day-discharge Safety of same-day-discharge radial percutaneous coronary radial percutaneous coronary

interventionintervention

943 Pts same-day discharge radial PCI: entry site complications 943 Pts same-day discharge radial PCI: entry site complications or repeat angiogram and/or PCI within 24 hours and 1 or repeat angiogram and/or PCI within 24 hours and 1 month , month ,

811 patients responded , 38 patients died, 94 alive but refused 811 patients responded , 38 patients died, 94 alive but refused to participate/impossible to contactto participate/impossible to contact

24 h 1 month24 h 1 month

Access complication (%) 2.8 0Access complication (%) 2.8 0

Chest pain (%) 2 11.5Chest pain (%) 2 11.5 repeat angio (%) 0.1 1.3repeat angio (%) 0.1 1.3 Vessel occlusion (%) 0 0.5Vessel occlusion (%) 0 0.5 (+ lost for FU pts) 0.2(+ lost for FU pts) 0.2

Ziakas Am Heart J. 2003; 146: 699-704


Transradial Approach for Transradial Approach for non- Coronary Diagnosis non- Coronary Diagnosis

and Intervention ?and Intervention ?


Transradial Approach Transradial Approach for nonfor non--Coronary Diagnosis andCoronary Diagnosis and

Intervention ?Intervention ?


Right Transradial selective Right Transradial selective vertebral and carotid vertebral and carotid

angiographyangiography

AuthorAuthor nnRight Right vertebralvertebral

Right Right carotidcarotid Left carotidLeft carotid

Left Left subclavian/subclavian/

vertebralvertebral

ChaCha 103103 98%98% 86%86%

NagayosNagayoshihi 8383 91%91% 100%100% 100%100% 56%56%

IwasakiIwasaki 526526 99%99%

NoharaNohara 6060 95%95%

IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud J. Théron, Caen, France, personal communication

Transradial carotid bifurcation stentingTransradial carotid bifurcation stenting


Transradial Approach Transradial Approach Drawbacks ?:Drawbacks ?:

It has to be learned (!)…It has to be learned (!)…and teachedand teached


Transradial Approach Transradial Approach Drawbacks ?:Drawbacks ?:I t I t has to has to be learned be learned (!)…(!)…

and teachedand teached


Radial approach learning curve in Radial approach learning curve in non selected populationnon selected population

0

10

20

30

40

50

60

70

80

90

100

1- 10 11- 20 21- 30 31- 40 41- 50 51- 60 61- 70 71- 80 81- 90

Fellow 1

Fellow 2

Fellow 3

52%69%89%

Y. Louvard, preliminary


Radial approach learning curve in Radial approach learning curve in non selected populationnon selected population

0

10

20

30

40

50

60

70

80

90

100

1- 10 11- 20 21- 30 31- 40 41- 50 51- 60 61- 70 71- 80 81- 90

+ Senior

+ Senior

+ Senior

96%97%98%

Y. Louvard, preliminary


Transradial Approach Transradial Approach Failure in Relation to Failure in Relation to

VolumeVolume

y = - 1,2931Ln(x) + 11,464

0

1

2

3

4

5

6

7

8

0 400 800 1200 1600 2000 2400 2800

p= 0.002

%

*Failure to enter ascending aorta*Failure to enter ascending aorta

Y. Louvard, unpublishedY. Louvard, unpublished


Predictive Factors of Radial Predictive Factors of Radial Approach FailureApproach Failure

Success Failure* pSuccess Failure* pn= 2347 53n= 2347 53

Age (years) 61.6Age (years) 61.6++11.3 6511.3 65++11.2 11.2 0.030.03

Male (%) 84 73.7 Male (%) 84 73.7 0.0680.068

Hypertension (%) 42.2 43.4 Hypertension (%) 42.2 43.4 nsns

Dyslipidemia (%) 72.9 69.8 Dyslipidemia (%) 72.9 69.8 nsns

Diabetes (%) 8.4 13.2 Diabetes (%) 8.4 13.2 nsns

Smoking (%) 26.9 22.6 Smoking (%) 26.9 22.6 nsns

Left radial (%) 3.2 18.9 Left radial (%) 3.2 18.9 0.0000.000

Re-radial (%) 21.9 17 Re-radial (%) 21.9 17 nsns

N° of Same Radial (n) 1.3N° of Same Radial (n) 1.3++0.7 1.30.7 1.3++0.6 0.6 nsns

N° Dis. Coro. Vessels (n) 1.8N° Dis. Coro. Vessels (n) 1.8++0.8 1.70.8 1.7++0.7 0.7 nsns

Weight (kg) 76.9Weight (kg) 76.9++13.5 72.813.5 72.8++13.8 13.8 0.0290.029

Height (cm) 169.3Height (cm) 169.3++8.3 166.48.3 166.4++10.3 10.3 0.030.03

*Failure to enter ascending aorta*Failure to enter ascending aorta


0

1

2

3

4

5

6

<40 y

n=64

40- 49 y

n=298

50- 59 y

n=606

60- 69 y

n=779

70- 79 y

n=552

> 80 y

n=110

Radial approach failure rate%

Radial Approach Failure Rate Radial Approach Failure Rate in Relation to Age in Relation to Age



Radial Approach Failure Rate in Radial Approach Failure Rate in Relation to WeightRelation to Weight

0

1

2

3

4

5

6

7

8

9

10

<50 kg 50- 59 kg 60- 69 kg 70- 79 kg 80- 89 kg 90- 99 kg 100- 09 kg >110 kg

Total Male Female



Predictors of Failure of Transradial Predictors of Failure of Transradial Approach for Coronary Angiography Approach for Coronary Angiography

and Interventionsand Interventions

Causes of the 475 TRA failures (7%): unsuccessful puncture (69%), Causes of the 475 TRA failures (7%): unsuccessful puncture (69%), difficult anatomy (16%), brachial artery spasm (8%), unsuccessful difficult anatomy (16%), brachial artery spasm (8%), unsuccessful canulation (5%) or miscellaneous (2%) canulation (5%) or miscellaneous (2%)

A multivariate analysis of a large series: 6,962 TRA (94-98)A multivariate analysis of a large series: 6,962 TRA (94-98)

G.Barbeau AHA 1999G.Barbeau AHA 1999


Evaluation of a spasmolytic cocktail to Evaluation of a spasmolytic cocktail to prevent radial artery spasm during prevent radial artery spasm during

coronary procedurescoronary procedures

Automatic pullback device, efficacy of an intra-arterial vasodilating cocktail Automatic pullback device, efficacy of an intra-arterial vasodilating cocktail (verapamil 5 mg, nitroglycerine 200 µg) in reducing radial artery spasm (verapamil 5 mg, nitroglycerine 200 µg) in reducing radial artery spasm

Cocktail No cocktail p valueCocktail No cocktail p value

N= 50 50N= 50 50

Pain (%) 14 34 0.019Pain (%) 14 34 0.019

Pain score 1.7 Pain score 1.7 ++ 0.94 2.08 0.94 2.08 ++ 1.07 = 0.03 1.07 = 0.03

Maximal pullback force (kg) 0.53 Maximal pullback force (kg) 0.53 ++ 0.52 0.76 0.52 0.76 ++ 0.45 = 0.013 0.45 = 0.013

MPF > 1.0 kg (%) 8 22 = 0.029MPF > 1.0 kg (%) 8 22 = 0.029

Kiemeneij CCVI 2003; 58: 281-4


Tortuous Right Subclavian Artery: Tortuous Right Subclavian Artery: Prevalence and Predictive FactorsPrevalence and Predictive Factors

2,341 consecutive right radial approaches2,341 consecutive right radial approaches

Prevalence (%) 10.8Prevalence (%) 10.8Cross-over to Left Radial or Femoral (%) 4Cross-over to Left Radial or Femoral (%) 4Complications (%) 0Complications (%) 0

Independent predictive factors:Independent predictive factors:

OR 95% CI p OR 95% CI p Hypertension 1.6 1.3-2.1 Hypertension 1.6 1.3-2.1

<0.0003 <0.0003 Age 1.4 1.2-1.7 Age 1.4 1.2-1.7

0.00010.0001BMI 1.2 1.0-1.4 0.015BMI 1.2 1.0-1.4 0.015

Cha CCVI 2002; 56: abst 69Cha CCVI 2002; 56: abst 69


Transradial Approach Transradial Approach Drawbacks ?:Drawbacks ?:ComplicationsComplications


Transradial Approach Transradial Approach Drawbacks ?:Drawbacks ?:ComplicationsComplications


A New and Objective Method for Transradial A New and Objective Method for Transradial Approach Screening: Comparaison With the Approach Screening: Comparaison With the

Allen's Test in 1010 PatientsAllen's Test in 1010 Patients

1010 pts, 32% female, 19% diabetics, age 62y, weight 76 kg, 1010 pts, 32% female, 19% diabetics, age 62y, weight 76 kg, height 1.66 mheight 1.66 m

Right Left Right or Right Left Right or LeftLeft

MAT MAT << 9 seconds (%) 87 86 9 seconds (%) 87 86

Positive PL* + Ox (%) 96 95Positive PL* + Ox (%) 96 95

MAT exclusion (%) 6.3MAT exclusion (%) 6.3

PL + Ox (%) 1.5PL + Ox (%) 1.5

Barbeau 2001, 37, 2, Suppl A, 1A-648ABarbeau 2001, 37, 2, Suppl A, 1A-648A

MAT: modified Allen’s test, plethysmography (PL) and oxymetry (Ox)MAT: modified Allen’s test, plethysmography (PL) and oxymetry (Ox)


Early ultrasonic resultsEarly ultrasonic results

Pre-procedurePre-procedure Post-procedurePost-procedure pp

Diameter (mm)Diameter (mm) 3.64 3.64 ± 0.74± 0.74 3.55 3.55 ± 0.77± 0.77 nsns

Upstream flow (cm/sec)Upstream flow (cm/sec) 29.13 29.13 ± 9.51± 9.51 30.8 30.8 ± 11.26± 11.26 nsns

Downstream flow(cm/sec)Downstream flow(cm/sec) 28.73 28.73 ± 11.84± 11.84 nsns

Duration (mn)Duration (mn) 2.92 2.92 ± 0.55± 0.55 3.35 3.35 ± 0.83± 0.83 nsns

270 patients4 radial occluded (1.3%) :

- 2 with a negative flow- 2 without flow

J. Monsegu


Radial Artery/Sheath Diameter Ratio: A Radial Artery/Sheath Diameter Ratio: A Predictor of Severe Radial Artery Flow Predictor of Severe Radial Artery Flow

ReductionReduction

0

24

68

10

1214

Radial I nner

Diameter / Sheath

>1

Radial I nner

Diameter / Sheath

<1

Severe Radial Flow Reduction

Saïto CCVI 46: 173-178, 1999


IVUS after transradial IVUS after transradial approachapproach

JACC 2003;41;1109-14


Use of the radial artery graft after Use of the radial artery graft after transradial catheterization: is it suitable as transradial catheterization: is it suitable as

a bypass conduit?a bypass conduit?

67 pts underwent isolated CABG using the radial artery (RA)67 pts underwent isolated CABG using the radial artery (RA)

preop. transradial no transradial p valuepreop. transradial no transradial p value catheterization catheterizationcatheterization catheterization

N= 22 45N= 22 45Stenosis-free graft patencyStenosis-free graft patency Left mammary artery (%) 88 90 = 0.87Left mammary artery (%) 88 90 = 0.87 Radial artery (%) 77 98 = 0.017Radial artery (%) 77 98 = 0.017 Saphenous vein (%) 87 84 = 0.42Saphenous vein (%) 87 84 = 0.42Intimal hyperplasia of RA (%) 68 39 = 0.046Intimal hyperplasia of RA (%) 68 39 = 0.046

Kamiya Ann Thorac Surg. 2003; 76(5): 1505-9

IInstitut nstitut CCardiovasculaire ardiovasculaire PParis aris SSudud From P Garot

False Aneurysm after PTCAFalse Aneurysm after PTCA


Conclusions (1)Conclusions (1)

Transradial approach is the best way to reduce the Transradial approach is the best way to reduce the vascular complication rate of diagnostic and vascular complication rate of diagnostic and therapeutic coronary (vascular) catheterism: less therapeutic coronary (vascular) catheterism: less expensive, preferred by patients and nurses…expensive, preferred by patients and nurses…

At the price of a slight increase in procedural At the price of a slight increase in procedural duration and X-Ray exposure for diagnosis onlyduration and X-Ray exposure for diagnosis only

It is specially effective in high risk populations like It is specially effective in high risk populations like old patients, AMI, patients treated with powerful old patients, AMI, patients treated with powerful anticoagulant or antiplatelet drugsanticoagulant or antiplatelet drugs


Conclusions (2)Conclusions (2)

Transradial approach allows the use of all Transradial approach allows the use of all devices and techniques of modern coronary devices and techniques of modern coronary intervention intervention

Peripheral vascular diagnosis and intervention Peripheral vascular diagnosis and intervention is feasible with the same advantages: is feasible with the same advantages: Subclavian, Renal, Mesenteric, Carotid?Subclavian, Renal, Mesenteric, Carotid?

Learn it in Kamakura Live Course…Learn it in Kamakura Live Course…

Institut Cardiovasculaire Paris Sud Radial Access: state of the art n Y. Louvard n Massy, France.

Documents

Transcript of Institut Cardiovasculaire Paris Sud Radial Access: state of the art n Y. Louvard n Massy, France.