You could learn more about cardiology courses with Prof. Sameh Allam by clicking on the courses’ library link here:

Objectives for this course:
1- Master the essentials of a successful complex PCI by using the radial approach
2- Essential questions on radial approach and the use of the specific radial device(s)
3- Clinical case strategy and radial approach limits
4- Anatomical variations in the Radial artery.
5- Master the essential steps of a successful radial procedure.

In this lecture, we will discuss:
1- On the Campeau Radial Paradox.
2- how to avoid complications like radial artery spasm.
3- Case about the difficulty engaging LM with XB Guide.
4- Toolbox for transradial interventions
5- How to start a successful transradial program.

The radial artery is increasingly adopted as the primary access site for cardiac catheterization because of patient preference, lower bleeding rates, cost effectiveness, and reduced risk of mortality in high-risk patient groups.
Concerns have been expressed that operators/centers have become increasingly unfamiliar with transfemoral access.
The aim of this study was to assess whether a change in access site practice toward transradial access nationally has led to worse outcomes in percutaneous coronary intervention procedures performed through the transfemoral access approach.

Transradial access (TRA) decreases vascular access site complications (VASC) compared to transfemoral access (TFA). This explains the gradual shift from TFA to TRA for percutaneous coronary intervention (PCI) worldwide.
However, the unintended consequences of such transition in real-world practice might be a deskilling in TFA technique with a subsequent paradoxical increase in VASC when TFA is attempted (a phenomenon we coined the “Campeau Radial Paradox”, which can be further amplified by an increase in patient/procedure-related complexity in recent years.

The recent widespread adoption of RA for cardiac catheterization has been associated with increased rates of VASCs when FA is attempted.

The outcome gains achieved by the national adoption of radial access are not associated with a loss of femoral proficiency, and centers should be encouraged to continue to adopt radial access as the default access site for percutaneous coronary intervention wherever possible in line with current best evidence.

Radial artery occlusion after transradial coronary catheterization
The transradial approach (TRA) for coronary angiography and interventions is increasingly utilized around the world. Radial artery occlusion (RAO) is the most common significant complication after transradial catheterization, with incidence varying between 1% and 10%. Although RAO is rarely accompanied by hand ischemia, it is an important complication because it prohibits future transradial access and radial artery utilization as a conduit for coronary artery bypass grafting or arteriovenous fistula formation. In this review, we discuss factors predicting the occurrence of RAO, aspects of accurate and prompt recognition, methods that contribute to its prevention, and possible treatment options.

Potential access site complications during percutaneous procedures performed via a transradial approach
1- Radial artery spasm
2- Persistent postprocedural pain
3- Upper extremity loss of strength
4- Hematoma
5- Pseudoaneurysm
6- Arteriovenous fistula formation
7- Radial artery perforation
8- Radial artery eversion during sheath removal
9- Hand ischemia
10- Compartment syndrome

In most cases, RAO occurs promptly after the procedure and up to 50% of patients have spontaneous recanalization of the artery within 1–3 months.

Learn more about the treatment. Prevention, and the management of these cases during this lecture.

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