Transradial Access in Primary PCI: A Call to Arms

Bernard J. Gersh, MB, ChB, DPhil; Malcolm R. Bell, MD; Mackram F. Eleid, MD


February 10, 2014

In This Article

Slow Adoption in the United States -- Why?

Dr. Eleid: The reasons aren't completely clear, but we think that, for one thing, there aren't many programs that train in the transradial approach. There are still many concerns from people out in practice about whether the transradial approach is feasible for the STEMI population. There are concerns about not being able to use larger guide catheters; only having up to size 6 French available, for example.

Dr. Bell: Some of the equipment has been available in some of those countries in advance of being available here.

Dr. Gersh: Really?

Dr. Bell: That has changed things. When we first started doing radial approaches, using the introducer sheaths, the big problem was avoiding a spasm. We have pretty much overcome that in most patients now. But, as usual, there is a lag associated with getting equipment into this country.

But I can't guess at the difference between the European and US interventional cardiologists. It may be just a coincidence. It may be that in a few pockets, a few places in Europe, they had physician champions of this technique and really pushed it, and it just happened to be the right people, in the right place, in an environment that was prepared to accept change. We see this a lot in other areas of medicine in Europe.

Dr. Gersh: US physicians and interventional cardiologists are not usually conservative by nature. They are aggressive, and they are aggressive in adopting new approaches, so it is interesting that there has been a long lag.

Dr. Bell: In our own lab, we have tremendous support, particularly from our allied health staff. But when we first started to adopt this, there always seemed to be some barriers to those changes. You need to have people who champion this approach, and generally this comes from younger individuals.

Dr. Gersh: I want to leave time for some discussion about patients who should not have the radial technique, but before that, do you think it would be indefensible to not train people in the radial approach in interventional training programs in 3 years' time? Do you think that every program will or should offer this?

Dr. Bell: It's a great question, and we address this to some extent in this article. Certainly among our junior colleagues and trainees, it has become an expectation that they are going to learn the transradial approach.

Dr. Gersh: When you have randomized trials showing a reduction in mortality and a reduction in bleeding, it seems almost inconceivable that one can ignore that.


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