Video : Sheathless Radial Artery Approach: tips & tricks

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Cardiology / Coronary / Pci / Live

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Equipment used

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With the kind participation of pioneers:

- Hakim Benamer, Hôpital Européen La Roseraie, Aubervilliers

- Benjamin Faurie, Groupe Hospitalier Mutualiste, Grenoble

- Yves Louvard, ICPS, Massy

Incathlab launches its educational series dedicated to coronary interventions using the transradial approach! Attend the first live web symposium that will open the series on September 1st and 2nd.

Dr Yves Louvard and Dr Hakim Benamer, who stand as pioneers in the field, will join Dr Benjamin Faurie's team to present and explain every step of coronary angiograms and interventions, through live demonstrations on simple and more advanced cases.

The transradial approach is a good option for patients' care, and may become the default access for coronary angiography and intervention in the next few years. However, its increasing role will depend on several factors, such as the operators' experience, the management of the costs, results from randomized studies, the improvements of a dedicated equipment and, of course, patients' decision.

Your patients and your practice deserve the highest level of state-of-the-art expertise.

Save the date now, and join this premium symposium.

Incathlab launches its educational series dedicated to coronary interventions using the transradial approach! Attend the first live web symposium that will open the series on September 1st and 2nd.
Dr Yves Louvard and Dr Hakim Benamer, who stand as pioneers in the field, will join Dr Benjamin Faurie's team to present and explain every step of coronary angiograms and interventions, through live demonstrations on simple and more advanced cases.

TOOL BOX Trans Radial Approach
Prepared by B. FAURIE & J. AZZI

1 - Puncture

- Home made plexiglass arm board for wrist hyperextension

- Emla® cream 1H before procedure on both wrists

- Local anesthesia with 1ml of Xylocaine® 1%.

- Venous canula 20 G built in the introducer kit

- Radial cocktail injected through the sheath: verapamil 3mg, Risordan® (Trinitrine) 2mg

- IV Heparin 70 UI/kg (100UI/kg if PCI)

2 - Introducers
- Cordis RadialSource™ introducer kit available in 6.5 - 10 – 20 cm in 4F, 5F and 6F with a short 20G venous canula and either 0.014" polymer coated guidewire or 0.018" spring guidewire

- Terumo Radifocus® introducer kit available in 7 and 10 cm in 4F, 5F, 6F with venous canula and plastic 0.021" wire

- Merit Medical Prelude® available in 4F, 5F and 6F

- Terumo Extralong (25cm) hydrophilic Radifocus® introducer for coronary spasm expertise (Methergin® testing) or extreme radial tortuosity. No spasmolytic cocktail administered

- Increase introducer diameter (4 to 5F or 6 or 7F...): Terumo or Cordis femoral introducer on the 0.035" J wire in place or SheathLess guiding catheter

3 - Wires for catheters advancement

- Cordis Emerald™ .035” J spring wire 150cm

- Boston Scientific .035” J spring wire 150cm

- Cordis .035" Aquatrack™, hydrophilic guidewire if failure of .035” spring wire

- Terumo.035” Angled Glidewire Advantage™ (180cm) if failure of .035” spring wire (Terumo Glidewire®: J Tip .035”, 180cm length, Product Code #HR35183M)

- .014“Abbott Vascular BMW®, Pilot® 50 in case of extreme radial tortuosity or loops

- No need for exchange wires (210 or 260cm) if you use the hydrophilic mandrin technique : strong serum flushing with a 10cc luerlock syringe over the .035’ wire leaning against the aortic cusp

- Amplatz Extra stiff spring wire 150cm if subclavian or inominate tortuosity or calcifications for catheters exchange

4 - Catheters
A- Diagnostic :

- Coronary :

- Cordis® 4 & 5F Judkins right and left (JL 3.5; JR 4), if elderlies patients or small sized persons

- Cordis® 5F Barbeau for other patients. 1 cath for LCA, RCA and LV

- Cordis® 5F and 6F RBL 4 / RBL 5, 1 cath for LCA and RCA

- Terumo TIGER (4; 4.5; 5) for LV angiogram: 5F Angled pigtail

For Bypass:

- JR for SVG and LIMA

- AL1 and Barbeau for SVG

- Cordis Modified Mammary cath for selective injection of RIMA and LIMA via Right Radial: IM Barbeau or IM Bartorelli Cozzi

- Cordis Multipurpose 5F for GE graft

-Peripheral angiogram:

- Cordis Multipurpose 125cm for selective injections of mesenteric, renals, iliacs

- Simmons for carotids and subclavian

- Cordis Markerband pigtail 125 cm (NEW!) for pre-TAVI aortic and ilio-femoral measurement

- Cordis and Cook Medical Pigtail 125 cm 4F and 5 F

B- Intervention :
-LCA :

- Cordis® Vista Brite Tip® 5 or 6F XB 3, 3.5, 4 – JFL ST and LT

- Terumo Heartrail® II BL 3.5, 4

- Medtronic Launcher® 5 or 6 F EBU 3, 3.5 , 4

- Asahi Intecc SheathLess 6.5, 7.5 or 8.5F. PB4

-RCA:
- Cordis® Vista Brite Tip® 5 or 6F Barbeau – JFR or AL1 if more backup needed

- Terumo Heartrail® II 5 and 6 F Ikari Right or AL1

- Asahi Intecc SheathLess 6.5, 7.5 or 8.5F. AL1 or 2

- Medtronic Launcher® AR1, AR2, ALR1,2, AL1 and AL2

- Peripheral :
a: Renal, Mesenteric :
- Cordis® Vista Brite Tip® 6F LBT MP 125cm or Barbeau 125cm
- Asahi Intecc SheathLess MP 100cm (small persons)

b: Iliac: Cordis® Vista Brite Tip® 6F LBT MP 125cm

c: Carotid: Cook shuttle® or Asahi Intecc SheathLess 7.5 or 8.5F MP 100cm

5 - Specific devices

Active intubation and mother and child systems

- Terumo Heartrail® II 5 in 6 - 120cm

- Vascular solutions Guideliner® 5-in-6, 6-in-7, 7-in-8

- Abbott Vascular Wiggle® .014” wire by for increasing deliverability of stents in tortuosity and calcifications

6 - Closing devices

- Home made rolled pile of gauze with elastic adhesive tape. Good for very thin wrist

- Zoom Co Médic Hemo Stop

- Terumo TR Band™ Product Code: XX*RF06 (Regular; 24cm)

- Access Closure Bengal™ Radial compression band

- Merit Medical Finale™ compression device

- Saint-Jude Radistop™ compression assist device

Shooting date : 2011-09-02
Last update : 2021-06-09

RADIALSOURCE™ / Cordis

Radial introducer

2 comments

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Sandeep M. Very nice

2018-08-14, 18h38
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Fatih K. Thanks

2019-05-15, 22h02
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Sheathless Radial Artery Approach: tips & tricks

Live session from the Groupe Hospitalier Mutualiste of Grenoble, France

Become an Incathlab member and receive full access to its content!

TOOL BOX Trans Radial Approach
Prepared by B. FAURIE & J. AZZI

RADIALSOURCE™ / Cordis

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TOOL BOX Trans Radial Approach Prepared by B. FAURIE & J. AZZI

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TOOL BOX Trans Radial Approach
Prepared by B. FAURIE & J. AZZI