Transradial Interventions at the Forefront of Innovation

Interventional cardiology has witnessed tremendous changes over the years from a mainly diagnostic approach in an elective population to therapeutic strategies in critically ill patients. Currently, we can treat a broad spectrum of coronary artery, peripheral artery, and structural heart diseases with less invasive, percutaneous approaches that we did not anticipate to be possible just a decade ago. It is certain that the interventional techniques will see further development and we will be able to treat by percutaneous methods more conditions previously thought beyond our reach. Regardless of the advances in catheter-based diagnostic and therapeutic techniques, one thing remains constant. They all require vascular access. And, vascular access is the first technical part of any percutaneous cardiovascular procedure that can determine its overall success. High-quality data together with the availability of training courses for interventional cardiologists and fellows-in-training ensure systematic use of the transradial approach (TRA) which has demonstrated a considerable benefit compared to transfemoral approach both in chronic and acute coronary syndromes. Constant improve- ment of TRA techniques will further facilitate transra- dial endovascular and structural interventions, and the growing use for high-risk and complex percutane- ous coronary interventions. A continuously growing body of evidence is focused on surpassing current TRA limitations (specifically radial artery occlusion) and expanding alternative vascular accesses such as transulnar approach or distal TRA (snuff-box tech- nique). Should this downsizing trend continue, we could see a further paradigm shift toward using the snuff-box technique. (Curr Probl Cardiol 2022;47:100884.)

Automated summary

Interventional cardiology has undergone significant changes, shifting from a diagnostic approach to therapeutic strategies using less invasive, percutaneous methods. Vascular access is a crucial technical step that determines the overall success of cardiovascular procedures. The transradial approach has shown considerable benefits in treating coronary syndromes and ongoing improvements in this technique will further expand its use.