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From femoral to radial access for PCI: Practical tips and observations for the community based interventional practitioner


The following are ten observations from my own experience, two years after adopting radial access in roughly 80% of my practice:

  1. Patients prefer it
  2. The procedure does take 5-10 minutes longer than femoral approach
  3. Concern about radial loops is unjustified
  4. No post-procedure complications
  5. By using the right wrist, much of equipment is the same as for femoral approach
  6. Mastering catheter manipulation into coronaries takes time
  7. Winning over the cath lab staff is essential but falls into place with experience
  8. "Failure" is less of an issue
  9. Rethink anticoagulation
  10. Procedures are 95-98% successful

 

See:

Bailout no more: Transradial PCI goes mainstream, but the US lags behind

The Fellows' Corner: Episode #11: Transradial access for PCI with Drs David Kandzari, Sunil Rao, and Philippe Généreux

Cardiac catheterization access sites: An international perspective

Two new studies support radial-access PCI over the femoral approach

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About Dr Seth Bilazarian
Seth Bilazarian MD has been a Clinical and Interventional Cardiologist at Pentucket Medical Associates in Massachusetts since 1993. He is board certified in Internal Medicine, Cardiovascular Medicine, Nuclear Cardiology, Vascular Ultrasound, Interventional Cardiology, and Vascular and Endovascular Medicine.

Dr Bilazarian performs coronary and peripheral interventions at Lahey Clinic and Massachusetts General Hospital. He has been an investigator in the interventional laboratory for new devices including drug-eluting stents, distal protection devices, imaging devices (OCT and InfraRed), and anticoagulant pharmacotherapy.

Dr Bilazarian is an active participant in clinical trials in congestive heart failure, hypertension, coronary disease prevention, prediabetes management, anemia, atrial fibrillation, and anticoagulation/antiplatelet therapies in the outpatient setting. He has authored numerous papers and book chapters in clinical cardiology. He was appointed as a physician advisor to the circulatory device panel of the FDA in 2008.
About this blog
My intent is to create a forum for dialogue on issues pertinent to private practice cardiology around topics such as:

  • Integration of new data and guidelines on inpatient and outpatient practice in clinical and interventional cardiology
  • Practice approaches to the extra clinical issues in dealing with managed care insurers
  • Strategies for navigating the restrictions of pharmacy benefits managers (PBMs) on pharmacologic therapies for our patients
  • Experiences with restrictions on testing and imaging
The video blog (VLOG) will provide an opportunity to share broadly different approaches to the common conundrums we face in caring for patients. My hope is that this forum will provide useful data points for practice outside of tertiary and academic centers and a look inside community hospitals and physician’s practice patterns in the office, starting with mine.