The Mid-Atlantic Radial Symposium (MARS) 2012
By: Kintur A. Sanghvi MD FACC FSCAI
Held Saturday, April 21, 2012, at the Gagnon Cardiovascular Institute, Malcolm Forbes Amphitheater, Morristown Medical Center, Morristown, New Jersey.
Reported by Kintur A. Sanghvi, MD, FACC, FSCAI, Director Transradial Program, Deborah Heart and Lung Institute, Browns Mills, New Jersey.
On Saturday, April 21, 2012, we had a very successful transradial course at Morristown Memorial Hospital, The Mid Atlantic Radial Symposium (MARS 2012). MARS 2012 was a one-day course focusing on basic as well as more advanced aspects of the transradial catheterization.
The symposium was organized to serve the interests of every potential participant and the education ranged from table set up and radial access to performing PCI of a left main chronic total occlusion through a very tortuous radial artery, originating from the axillary artery. There was also a dedicated symposium for the nurses and technologists, focusing on the details of the pre- and post-procedure care of transradial patients. In addition, every physician participant was given a copy of the new Patel’s Atlas of Transradial Intervention: The Basics and Beyond, considered a “must-read” and “the Bible of transradial intervention” (http://www.patelsatlas-basicsandbeyond.com/).
In 2005, when the transradial working group of the Society for Cardiovascular Angiography and Interventions (SCAI) was formed at the annual SCAI meeting in Ponte Vedra Beach, Florida, only 4 people were in the room: myself, at that time a first-year cardiology fellow, Dr. John Coppola, Dr. Samir Pancholy, and one more physician (I unfortunately cannot recall this person’s name). In dramatic contrast to that situation, MARS 2012, a local conference, had 120 participants. This tremendous increase of interest in transradial catheterization is because of a few dedicated radialists who believed in and relentlessly perused their passion of learning about and teaching this patient-friendly, minimally invasive, “drive-through” approach. The increased interest in transradial catheterization is also driven to a great extent by our patients, as they overwhelmingly prefer the radial approach and demand their procedure be done through the wrist.
In 2007, only 1.5% of the cardiac catheterization procedures were done by radial access in the United States. American College of Cardiology National Cardiovascular Data Registry (ACC-NCDR) data from 2011 showed that radial artery access has increased to 11%. Now physicians are requesting courses on how to complete the procedure via radial access in “EVERY” patient. Some of the participants in the course did not want to just hear about the deep inspiration technique, but wanted to take the discussion beyond the basics. Our symposium tried to address the need of the interventional community. Dr. Sunil Rao from Duke University was one of the faculty members. “MARS 2012 was an outstanding course that covered the essentials of the radial approach from basic to advanced,” he said. “Using solid, evidence-based presentations, all relevant aspects of transradial procedures were covered that, coupled with complex case reviews, made it a must-attend meeting." Until 2009, when I went to any cardiology meeting, interventionalists would commonly say, “We don’t need to do radial; patients do just fine with the closure devices and Angiomax.” Now, during these meetings, you are more likely to hear “I do radial when needed” or “I do 80% radial.”
In 2013, attendees can look forward to a similar or perhaps even more advanced course, including live case transmission. Ultimately the patients, the health care industry, and society are the winners with the increased implementation of radial access, although I am uncertain if we as a country are going to meet the 50% radial use mark, like the U.K. and France. The low individual average volume of only 70 cases per interventionalist each year may limit us from reaching that milestone. With more and more fellowship programs now training their fellows to perform radial access, however, we are one step further in achieving this goal.
Learn more about MARS 2012 at http://www.mars2012.org/.
As a patient who has had over 10 procedures one by the wrist. I will never let the wrist be used again. It was painful and caused nerve damage to my wrist. Know of 2 other people who will not ever let this occur again due having problems. As a patient it was not friendly to me I was told that it would be from cath team when I questioned knowing of my friends bad exoerience so I so ok. After my bad experience I feel that I was lied to. Part of the problem in my case is that I had a history of 3 past surgeries on the same wrist.
Reply to this comment »I am sorry to hear you were not pleased by this treatment. I perform transradial procedures since 1992. Of course in these 20 years I have had patients who suffered much pain, especially if the artery is small in relation to the catheters or if the artery is in spasm. However, these problems are rare and can be overcome. But some patients remain unsuitable for transradial approach. Perhaps your surgery may have played a role.
Please notify your physician that you prefer femoral (groin) approach. Take into consideration the higher risk for bleeding. Take time to discuss the pro's and con's.
Kind regards in hope of a uneventful cure
Ferdinand Kiemeneij
Reply to this comment »I am sorry that you had a painful experiance with your radial catheterization. I am wondering if it was becuase of the 3 previous surgeries in the same wrist.
Every invasive procedure has its risks along with the benifits. The worst complication with a transradial access is acute/chronic pain syndrome becuase of severe spasm or inflammatory response. The worst complication with a transfemoral access is Death. For that reason, and knowing the data of the access related complication in every clinical scenario, I believe that radial access should be considered first in every patient requiring catheterization and used in right patients.
I hope you are feeling better
Reply to this comment »I've been in in the Cath Lab, Interventional Vascular arena for 20 years. In addition I married a man who is a 'vasculopath" with several cath procedures and CABG in that 20-year span.
Reply to this comment »I would not want a cath done on me unless they attempted radial access first. I have also recommended radial access to my husband should he need to have an arteriogram in the future.
We need more clinicians trained in transradial approach in the US. It's one more area where the
physicians in Europe have surpassed the physicians in the US.
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