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HISTORY

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The first known attempt at radial artery access for angiography was made in March 1947 by Dr. Stig Radner in Lund, Sweden. He reported on his new technique a year later, describing a radial artery cutdown in the upper third of the forearm, after which a 7-Fr to 9-Fr catheter was advanced in a retrograde fashion to perform a thoracic aortogram.1 It was not until over 4 decades later that the radial artery started to be accessed percutaneously, rather than through a cutdown, and for the purpose of cannulating the coronary arteries. In 1989, emboldened by the safety of the radial arterial line for critically ill patients, Dr. Lucien Campeau from Montreal Heart Institute described his experience of accessing the left radial artery for coronary angiography in 100 patients (90 men and 10 women).2 Primarily using a 5-Fr system, he was successful in cannulating the radial artery in 90% of patients, and reported only 2 complications, including a brachial artery dissection and a radial artery occlusion, neither of which were symptomatic. Three years later, in 1992, the first coronary stents were placed in 3 men via the right radial artery by Dr. Ferdinand Kiemeneij in Amsterdam.3 He attributed his ability to do this to “miniaturization” of coronary guiding catheters to 6-Fr and adequate crimping of a Palmaz-Schatz stent on a balloon to allow it to pass without becoming dislodged within the small guide.

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Following these successes, the use of radial access spread worldwide. However, the enthusiasm was short-lived in some countries, including the United States, where there was a rise and fall of radial procedures during the 1990s. United States operators quickly grew frustrated by the difficulty in performing a radial procedure compared to the ease of a femoral procedure, in which there were not issues of spasm, tortuous anatomy, or limitations in guide size. By the late 2000s, 50% of percutaneous coronary interventions (PCI) were performed radially in Europe and Canada, and 60% in Japan, but only 1.7% in the United States, putting it on par with the Middle East and Africa.4,5 Around the same time, though, concerns regarding the morbidity and mortality associated with bleeding and vascular complications, the emergence of new radial-specific equipment, and the enthusiasm of young operators who had no memory of the struggles of their predecessors, began to take hold. Within a 6-year period, radial PCI in the United States grew to over 30%, and has not shown signs of stopping (Fig. 22-1). Few interventional fellows in the country now graduate without being proficient in both radial and femoral procedures, and a new paradigm is seen within cardiac catheterization laboratories across the country where patients can ambulate right after their procedure and go home that same day.

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FIGURE 22-1

Percentages of radial percutaneous coronary interventions in the United States from 2007 to 2015.

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