Coronary revascularization does not always lead to coronary reperfusion. When readily available, percutaneous coronary intervention (PCI) using primary balloon angioplasty, with or without use of stenting, is the standard of care for ST-segment elevation myocardial infarction (STEMI). However, there is a group of patients who seem not to benefit fully from prompt restoration of antegrade flow, as they fail to show resolution of the indirect signs of ischemia such as electrocardiographic (ECG) changes and improvements in perfusion abnormalities.[1,2] These patients also present an angiographic phenomenon characterized by evidence of slow-flow in the affected vessel (Thrombolysis in Myocardial Infarction [TIMI] flow equal to or less than 2) and lack of contrast uptake “blush” by the subtended myocardium, leading to a potential dissociation between coronary revascularization and myocardial perfusion in STEMI.

Swedish SCAAR Registry data were presented in May during the EuroPCR meeting in Paris. The 30-day ST-elevated myocardial infarction (STEMI) mortality was 4.4% in the femoral access group vs. 3.2% in the radial access group (adjusted odds ratio 0.57, p<0.01). The benefit of radial approach was present at one year as well (7.3% femoral vs. 6.2% radial mortality, adjusted OR 0.78, p=0.018).

Transradial catheterization is increasingly becoming the access site of choice for many hospitals throughout the United States. Completing the procedure through the arm offers greater satisfaction for the patient as a result of increased comfort and patient mobility compared to femoral artery access. Radial artery access for cardiac catheterization is associated with a different set of complications and although infrequent, they present a challenge to cath lab staff to manage and prevent these issues as they appear. Education about the benefits and challenges of transradial catheterization is an important tool to nurses and technologists as they transition to cardiac catheterization through the wrist. This article will discuss patient satisfaction of radial versus femoral artery access and two of the most prevalent complications of transradial catheterization.

A drug-eluting, self-expanding stent that does not use a drug-carrier polymer is before the U.S. Food and Drug Administration (FDA) final pre-market approval (PMA) review and a decision is expected later this year. Its chances of approval appear very bright, considering its positive clinical trial data to date.

Catheter-based intra-cardiac echocardiography (ICE) is an imaging modality similar to intra-vascular ultrasound (IVUS). It allows imaging inside the heart to visualize cardiac structures and blood flow using Doppler imaging. The standard-of-care for this type of imaging is usually transesophageal echo (TEE), but ICE proponents say the intra-cardiac modality has several advantages.