Transradial #Radialfirst State of the Art at #SCAI2017

Dr. Sanjit Jolly spoke of the "radial paradox," and as it turns out, good transradial operators are not poor femoral operators.

Dr. Pine discussed complications after transradial access, including pain, hematoma, nerve damage, and vascular disruption. In general, these complications are rare, but we all need to be aware of them so that they are identified and treated quickly.

• Hand ischemia is quite rare, and usually due to embolization and spasm, and rarely due to access complications. 
• There really is no reason to do an Allen's test any more. -Valgimili: JACC 2014. Most high volume centers are either no longer doing this, or are simply ignoring the results. 

Is there an increased risk of stroke, when using transradial access? Dr. Cohen, starting his talk with a case of a massive stroke after transradial PCI. While this complication is rare (<0.2% of all cases), it's traumatic to the patient (and operator) when it happens. Small studies have suggested that L transradial may be associated with increased catheter exchanges, and may be reduced by L radial access. Comparisons between radial and femoral access show increased emboli, but no clinical changes, and more recent studies still favor transradial as, overall, lower risk due to superior safety without significant increase in neurologic outcomes. 

Dr. Gilchrist spoke of the cost differences between transradial and femoral. In general, there's a ~300$ reduction in cost when doing radial cases, without a loss in throughput. Cost savings are due to:

• Fewer complications (especially bleeding)
• 800-1600$ reduction in cost depending on their likelihood of bleeding 
• Improvement in throughput (e.g. SAME DAY DISCHARGE)

Transradial can be your leverage to start increasing discharges. 

• Estimates of cost (A Amin 2017) suggest that almost $3700 can be saved with a same-day transradial discharge. 

Jeffrey M. Schussler, MD, FACC, FSCAI

@Updock