If we say “transradial,” what’s your first reaction?
- “I’m comfortable doing femoral access, thank you very much.”
- “I’ve been hearing so much about radial lately — maybe we should learn more.”
- “We do a few radial access procedures, mostly on obese patients.”
- “We are a mix — some of our docs do lots of radial procedures and some don’t.”
- “Our lab is a radial-first lab — and we and our patients love it.”
Chances are, you are somewhere on the spectrum above. Interest in transradial procedures has exploded in the United States over the past few years, because of its ability to dramatically reduce bleeding complications, provide faster time to patient ambulation, increase the ability to discharge patients same-day and reduce costs (with additional data soon to be released).
Transradial access is not exactly a new idea, but a lack of dedicated equipment was one barrier to its widespread acceptance and use in the United States (Europe traditionally has been at a significantly higher rate of use). Cath Lab Digest talks with Gary Clifton about how Terumo has facilitated the growth of transradial access not only with products manufactured specifically to aid in transradial access, but by partnering with physicians, emphasizing education, and increasing availability and access to radial training around the country.
It has been over four years since Terumo began marketing transradial access. What has changed during that time?
Terumo actually had a very humble beginning back in 2007 with the introduction of our only product, the hydrophyllic Glidesheath™. During the ensuing year, we introduced additional products like the TR Band™ and our Optitorque™ Tiger and Jacky catheters, and we really began to see significant growth of the radial procedure year over year. In recent years, we added to the radial product offering with dedicated guide catheters, such as the Heartrail™ III Ikari. With each passing year, there was greater attention and emphasis on radial procedures at the various cardiology meetings, and publications on radial exploded during this time. Today we are seeing widespread use of the radial procedure around the country. So much, in fact, that for a growing number of cardiologists, radial is the default, not the alternative.
There are obviously a lot of people at Terumo behind transradial.
Yes, absolutely. We have an unbelievably strong and knowledgeable team. Everyone from our clinical, education and training, marketing communications and sales teams have been focused on delivering the radial value proposition. The driver and orchestra leader behind all of these efforts is Product Manager Shinikequa White. She works very closely with all stakeholders, internal and external, and is preparing to take Terumo to the next level in all our radial efforts.
Terumo chose to invest in education and training.
We knew early on that in order to drive greater utilization of radial access we would need to understand what the barriers were. It quickly became evident that except for maybe a couple of fellowship programs around the country, physicians were not being specifically trained in radial access. Along with our Training and Education department and our Field Clinical Team, we began to work with some of these programs to facilitate greater exposure, and to create mini programs where physicians could thereby spend a day or two and learn the fundamentals of radial access. Since that time, we have gone on to partner, collaborate, and facilitate numerous education and training opportunities across the country. Several years ago, we partnered with HMP Communications to develop an educational website (http://www.transradialuniversity.com) that, to this day, remains very non-promotional and offers a wide variety of videos, publications, and discussions with clinical experts. It serves as a central hub where any healthcare professional can go and learn more about radial access.
To what do you attribute the growth of transradial access?
It really is a multi-factorial set of circumstances, but Terumo did have a major role. Since the beginning, Terumo has been very active in driving awareness, and supporting and providing educational and training at a wide range of venues. Terumo became very active at meetings like the American College of Cardiology (ACC) Scientific Sessions, Transcatheter Cardiovascular Therapeutics (TCT), and the smaller regional meetings that are part of the cardiology landscape. We were, and we continue to be, front and center in generating awareness through our marketing and public relations efforts. We continue to participate or provide educational venues on an ongoing basis. In addition, I think there is a critical mass of physicians that believed transradial was solving a problem, i.e. access site complications, and the costs and clinical concerns associated with bleeding. I believe we should prepare to see another significant growth period due to what we are learning about how the economics of radial access may provide significant benefits to our healthcare system.
Can you talk more about the economics behind radial access?
We intuitively believed that if complications could be reduced, that there was inherent savings to the healthcare system. However, there are many costs associated with complications, and these are not easily understood and tracked by most hospitals. We developed a relationship with The Medicines Company several years ago and undertook a project to study the economics of radial versus femoral access. That study is now complete, is in publication, and I think it will be very enlightening. In addition, we saw at the 2012 ACC, and I believe we will see the same at this year’s ACC, a number of abstracts, presentations, and detailed information about cost savings when utilizing radial access. Furthermore, there is a fair amount of data that has been generated through organizations like The Advisory Board that are demonstrating how hospitals are utilizing radial access as a means to not only manage costs, but facilitate greater utilization of outpatient as well as same-day discharge procedures.
Can you describe the relationship Terumo has with The Medicines Company?
We began working together about three years ago and since then, we have collaborated on numerous occasions to facilitate greater awareness, education, and training about bleeding and pharmacology strategies. The Medicines Company has an internal consulting group, VITA, which we worked closely with to facilitate an economic study that they carried out over the past two years. They have done some great work in helping to tease out the costs associated with percutaneous coronary intervention. The upcoming publication of this data will bring greater light and understanding to issues of cost, access, and pharmacology.
Who does transradial benefit?
That is the great thing about radial access. Everybody wins. Physicians tell me how it has transformed their practice. They see numerous benefits, but if I had to summarize, I think most physicians would say they are doing it because they are finding a greater level of patient satisfaction and it obviates any of the concerns consistent with groin complications. Nursing and technical staff is excited about the advantages radial brings to their patients during and after the procedure. And not having to manage groins is a big plus. I have been in numerous hospitals around the country that tell me how radial has transformed their care delivery in the cath lab and how it is helping drive better throughput, reduce costs and increase patient satisfaction, which is a big issue in the current healthcare climate.
Why is transradial important to Terumo?
It’s what we do. We have been doing this globally for a decade. We have had influence around the world and it is something we believe is important. It is a good feeling to know when you are delivering products, education, and training, that is making a difference in so many lives. Everywhere I go, people are telling me what a positive impact radial access has been to them personally or to their hospital. And that’s a good thing.
Does Terumo have any new products coming in the future for radial access?
Yes, we do. Stay tuned! We will be launching something very innovative in the coming months.
“Transradial access came to the United States quite a bit later than expected. Despite the inertia, by persisting and providing growing opportunities for learning this technique, we have now seen a steep surge in the number of radial procedures. The credit goes to a bunch of passionate operators, organizations, such as SCAI, and our industry partners. If you look at any group photograph from a radial course in the United States, you will find Terumo in it. Thank you, Terumo, for all your effort and involvement in improving the safety of our patients.”
Samir B. Pancholy, MD, FACC, FSCAI, The Wright Center for Graduate Medical Education and The Commonwealth Medical College, Scranton, Pennsylvania
“I made the transition to transradial artery access for cardiac and vascular procedures approximately 3-4 years ago. It was a decision I made in an effort to reduce access site-related complications and to improve patient comfort. I have had no regrets and now perform most cardiac cases (70-80%) and many peripheral cases using this approach. It is my preferred approach for all STEMIs.
“It is very gratifying to know that when you are done with a case your focus can appropriately be placed on patient comfort, education, and early mobilization — not prolonged bed rest, pain medications, and vascular complications.
“I anticipate that transradial artery access utilization rates will increase with advances in technology, continued focus on health care costs and safety, and as more fellows leave training comfortable with the procedure. For physicians out of fellowship wanting to start using the technique, I would recommend a dedicated approach with the intention of tackling the steepest part of the learning curve in a relatively short period of time. Simulated and ‘gloves on’ training programs exist to help with this process.”
Peter Mason, MD, MPH, RPVI, Director, Interventional Vascular Medicine, Assistant Professor, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin
“Mid America Heart Institute has a long tradition of angioplasty training for practicing cardiologists in the U.S. Over the past 4 years, we have collaborated with Terumo on our Basic and Advanced TRI training courses. Their commitment to education and training has been remarkable and consistent.”
Dmitri Baklanov, MD, Saint-Lukes Mid America Heart Institute, Kansas City, Missouri