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Radial Access in Practice
Since 2009, use of radial access has steadily grown at Morristown Medical Center in Morristown, N.J. With just 2.9% of PCI procedures being performed using the radial artery that year, the number nearly quadrupled in 2 years to 10.9%. The number of diagnostic catheterizations also substantially increased over the years, from 2.6% in 2009 to 12.3% in 2012.
“It’s been a very easy transition to radial,” said Jordan Safirstein, MD, interventional cardiologist at Morristown Medical Center, and one of the only high-volume operators in New Jersey to routinely use the transradial approach for cardiac catheterizations and stent implantations. “There’s really not that much different about it compared with the transfemoral approach. And, importantly, the staff recognized the benefits right away. The patient was sitting up; they didn’t have to hold pressure on the groin; the patient was more comfortable and could often go home the same day regardless of whether a stent had been placed. These things really helped the staff become supportive of the approach.”
To find out more about this procedure firsthand, Cardiology Today’s Intervention attended a radial intervention case at Morristown Medical Center and spoke with several staff members in addition to Safirstein to find out about their own personal experience with the approach. This included John Muttel, X-ray technician, who, prior to his first transradial case, was unenthusiastic about working in the artery.
“Since the radial artery is small, I felt that the rate of complications would be higher [compared with femoral access],” Muttel said. “What I have found since is that if it were me on the table, I’d want radial: The recovery time is a lot quicker; it’s less invasive; there’s less risk for bleeding complications; and it’s an overall more pleasant experience.”
These benefits were echoed by the patient himself, Jeff McGinley, who had previously undergone a radial artery procedure in 2010 and felt confident that it was once again the right approach. “For me, a big part of the decision-making process was being able to continue the exercise regimen I’m on as soon as possible,” McGinley said prior to undergoing catheterization. “The last time I underwent this procedure, I was back on the treadmill the next night. And the fact that I could do that has really helped set my mind at ease this time.”
Images by Robert Sciarrino for Cardiology Today’s Intervention
The sheath is flushed in preparation for the procedure.
John Muttel, cardiovascular technologist, prepares the table prior to transradial cardiac catheterization.
Jordan Safirstein, MD, shortly before the procedure.
Jennifer Marion, cath lab nurse, checks on the status of the patient.
Roger Marvin, cardiovascular technologist, monitors the case behind the glass, keeping track of the patient’s BP and heart rate and documenting the events of the case.
From top left (counter-clockwise): Pulsatile flow from the catheter is observed; the guidewire is advanced; insertion of Terumo 6F guide sheath; and catheter insertion through the sheath.
After assessing the 80%-90% occluded vessel (above), Safirstein explains to the patient about the need to implant a drug-eluting stent (Resolute, Medtronic) to treat the lesion (below).
(Far above) The stent is deployed, leading to the final angiographic result seen below.
From top left: The TR Band (Terumo) is placed on the radial artery; the band is then inflated and the sheath is pulled out; and excess air is removed from the band.“The TR Band provides patent hemostasis, allowing the physician to adjust the amount of pressure on the radial artery to ensure it stays open while it is compressed just enough to prevent bleeding,” Safirstein said.
McGinley, with the help of the cath lab staff, is able to prop himself up to be moved off the operating table and onto the gurney.
Just minutes after being wheeled out of the cath lab, McGinley is sitting upright and discussing his experiences during the procedure:“I feel pretty good. I get to go home today and exercise on the treadmill tonight, which is great,” McGinley said after the procedure. “Aside from the one rupture of probably pre-existing plaque, all the vessels looked as good or better than they did last time, so that gives me more impetus to keep maintaining a healthy lifestyle,” McGinley said.
McGinley with his daughter, Anabelle, and wife, Rosa, at Disney World, just 1 month following the procedure. “Over the 11-day trip, I took Anabelle on 20 coasters and nearly a dozen motion simulators,” McGinley said. “The quick recovery time from the radial procedure let me get right back to exercising, just like my first procedure, allowing me to have the stamina for 11 days of constant walking, and the confidence in increasing my heart rate to enjoy the excitement of all the rides.”
Image: Jeff McGinley