Achieve Radial Access with Ease

Merit Medical PreludeEase Hydrophilic Sheath Introducers

By Alicia Armeli

PreludeEase?—Merit Medical’s newest line of Hydrophilic Sheath Introducers—has made the transradial artery approach even better. Studies show that hydrophilic coating on sheath introducers can reduce the incidence of artery spasm and improve patient comfort during transradial diagnostic and interventional coronary procedures.1

In recent years, the transradial approach has become increasingly popular for diagnostic and interventional coronary procedures. In comparison to transfemoral access, the transradial approach is linked to fewer vascular complications, shorter hospital stays, and reduced mortality.2 Financially, using the transradial technique may reduce direct and indirect hospital costs, while minimizing the overall financial burden from a larger social perspective.3,4

Notwithstanding these benefits, vascular complications can arise. More specifically, radial artery spasm is a common complication during transradial procedures and can lead to severe patient discomfort and diminished procedural success.1,5

A team of researchers at the Liverpool Heart and Chest Hospital in Liverpool, UK, examined the impact hydrophilic-coated sheath introducers had on the rate of radial artery spasm.1 In all, 790 patients scheduled for a transradial coronary procedure were randomly assigned hydrophilic-coated or uncoated sheath introducers. Results published in the Journal of the American College of Cardiology showed that radial artery spasm was seen significantly less in patients using a hydrophilic-coated sheath introducer (19.0% vs. 39.9%). Within the hydrophilic-coated group, less discomfort was also reported (15.1% vs. 28.5%). Sheath length didn’t influence these outcomes.

These results only mirror findings of numerous other studies. Saito et al. found sheath introducers with hydrophilic coating to lessen friction resistance by 70% in an in vitro model, which helped with sheath removal.6

A study published in Catheterization and Cardiovascular Interventions further investigated whether hydrophilic coating reduced the required force of sheath removal and any associated patient discomfort.5 Through a randomized double-blind comparison, Kiemeneij et al. analyzed 90 patients undergoing transradial percutaneous coronary intervention. Each patient received a sheath of identical length and diameter—the only difference being the presence or absence of hydrophilic coating.

Findings showed 3 patients (7%) in the coated group reported discomfort versus 12 patients (27%) in the uncoated group. Required force, measured in maximum and mean pullback force, was also significantly lower in the coated group.5

In addition to hydrophilic coating that extends to the sheath tip, the kink-resistant PreludeEASE tubing helps to provide procedural reliability. Smooth transitions between wire to dilator and dilator to sheath were designed for ease of insertion and can help enhance patient comfort. Available in 4F through 7F diameters and multiple lengths, PreludeEASE anticipates various clinical needs and diverse patient anatomy without compromising its slim profile and large inner diameter.

PreludeEASE sheaths are available in a variety of kit configurations, including one and two-part access needles, several guide wire options, a BowTie? Guide Wire Insertion Device, and more. In addition, Merit can customize PreludeEASE radial access kits to meet both specific and a wide variety of clinical needs.

PreludeEASE Hydrophilic Sheath Introducers complement Merit’s growing line of products designed to support radial access procedures from preparation to hemostasis. In this way, PreludeEASE can help interventional cardiologists not only perform radial access procedures with success—but with ease.

Please consult product labels and inserts for any indications, contraindications, potential complications, warnings, precautions and directions for use.

REFERENCES

  1. Rathore, S., Stables, R., Pauriah, M., Hakeem, A., Mills, J., & Palmer, N. et al. (2010). Impact of length and hydrophilic coating of the introducer sheath on radial artery spasm during transradial coronary intervention. JACC: Cardiovascular Interventions, 3(5): 475-483. https://www.ncbi.nlm.nih.gov/pubmed/20488402
  2. Schussler, J., Vasudevan, A., von Bose, L., Won, J., & McCullough, P. (2016). Comparative efficacy of transradial Versus transfemoral approach for coronary angiography and percutaneous coronary intervention. The American Journal Of Cardiology, 118(4): 482-488. http://dx.doi.org/10.1016/j.amjcard.2016.05.038
  3. Amin, A., House, J., Safley, D., Chhatriwalla, A., Giersiefen, H., & Bremer, A., et al. (2013). Costs of transradial percutaneous coronary intervention. JACC: Cardiovascular Interventions, 6(8): 827-834. doi: 10.1016/j.jcin.2013.04.014. https://www.ncbi.nlm.nih.gov/pubmed/23871512
  4. Ko?towski, ?., Filipiak, K., Kochman, J., Pietrasik, A., Huczek, Z., & Balsam, P. et al. (2016). Cost-effectiveness of radial vs. femoral approach in primary percutaneous coronary intervention in STEMI – Randomized, control trial. Hellenic Journal Of Cardiology, 57(3): 198-202. http://dx.doi.org/10.1016/j.hjc.2016.06.005
  5. Kiemeneij, F., Fraser, D., Slagboom, T., Laarman, G., & van der Wieken, R. (2003). Hydrophilic coating aids radial sheath withdrawal and reduces patient discomfort following transradial coronary intervention: A randomized double-blind comparison of coated and uncoated sheaths. Catheterization And Cardiovascular Interventions, 59(2): 161-164. http://dx.doi.org/10.1002/ccd.10444
  6. Saito, S., Tanaka, S., Hiroe, Y., Miyashita, Y., Takahashi, S., & Satake, S. et al. (2002). Usefulness of hydrophilic coating on artery sheath introducer in transradial coronary intervention. Catheterization And Cardiovascular Interventions, 56(3): 328-332. http://dx.doi.org/10.1002/ccd.10202

Alicia Armeli is a Freelance Writer and Editor who specializes in medical technology, health, and?wellness.

Merit Medical is Looking Forward to SIR this Weekend

Liu-and-Klass

Merit Medical and ThinkRadial will host several exciting events at the Society of Interventional Radiology annual meeting in Vancouver, BC, Canada from April 3-6. A series of activities taking place in Merit’s booth, #419, will provide attendees with a chance to learn about Merit’s innovative offerings through both hands-on experience and interactive presentations from transradial intervention and embolotherapy experts.

The first of Merit’s live presentations will take place from 9:30 am to 10:30 am on April 5. In this session, Dr. David Liu, MD, FRCPC, FSIR, will discuss “The Development and Evolution of?a Hepatocellular Carcinoma Embolotherapy Program: Rationale, Experience and Approach at Vancouver General Hospital”. From 12:00 pm to 1:00 pm on April 5, Dr. Darren Klass, MD, PhD, MRCS, FRCR, FRCPC, will host “Transradial Approach – Beyond the Basics: A Discussion of Cases and Tips With Expert Interventional RadialistTM, Dr. Darren Klass.”

Booth visitors will also have several opportunities to interact with and learn more about Merit’s product line supporting transradial intervention, including the most comprehensive offering of transradial access tools for Interventional Radiology; patient set-up, access, angiography, intervention and hemostasis, and for the first time, the Performa? Transradial Peripheral Angiographic catheter in longer lengths for peripheral radial access. ThinkRadial’s one-of-a-kind radial vascular model will also be available for hands-on product demonstrations.

Merit will also showcase products dedicated to the latest in embolotherapy interventions, including Embosphere? Microspheres, QuadraSphere? Microspheres (cleared in US and now additionally indicated for hepatoma), and HepaSphereTM Microspheres (indicated for use with or without doxorubicin outside the US).

At SIR, Merit will also showcase the following products:

  • HeRO? Graft, recently acquired from Cryolife, Inc.
  • CorVocet? Biopsy System*
  • SwiftNINJA? Steerable Microcatheter**
  • PAK? Pedal Access Kit***
  • Advocate? PTA Catheters
  • SPINR? High-Performance Guide Wire Controller
  • One-Step? Centesis Catheters with Pigtail
  • Performa? Transradial Peripheral Angiographic catheter in longer lengths

Additionally, Merit team members will be available to discuss their recent transition from a distributor model to a direct sales model for Canadian customers.

* Not available in EU or CAN.
** Available in EU. Not available in US or CAN.
*** Not available in CAN.

Article: Transradial access for IR’s is gaining traction –An interview with three Interventional Radiologists

Interventional Radiologists interviewed about transradial access

In its November issue, Interventional News reports that transradial access for Interventional Radiologists is gaining traction, as evidenced by the full room of attendees at a satellite symposium about the radial approach, sponsored by Merit Medical during the Cardiovascular and Interventional Radiological Society of Europe’s annual meeting in September. In the article, Interventional News interviews the three symposium speakers, all interventional radiologists who are experts in the radial approach: Dr. Christoph Binkert, a professor of Radiology in Zurich, Switzerland; Dr. Aaron Fischman, an Interventional Radiologist and assistant professor of Radiology and Surgery, Mount Sinai Medical Center, New York, USA; and Dr. Darren Klass, Interventional Radiologist, Vancouver Coastal Health, Vancouver, Canada.

The three physicians outline the benefits to patients of radial artery access over transfemoral access and potential complications and data that shows a very low complication rate. They also comment on the need for radial-specific devices. In his commentary Dr. Klass discusses reasons why many interventional radiologists are hesitant to change to the radial approach and some of the reasons why these hesitations should be overcome. Finally, the article includes the top tips for starting a radial service, as provided by Dr. Klass.

Read the full?Interventional News article.

Merit Medical’s ConcierGE? Guiding Catheter Now Available in Radial-Specific Shapes

Minimizing the number of catheter exchanges is important for transradial interventions in order to reduce the likelihood of spasm.1?Using catheters with radial-specific shapes may help radial operators minimize the number of catheter exchanges that can result in spasm.1

To meet the needs of radial diagnostic and interventional procedures, Merit Medical now offers the Ultimate 1 shape in both diagnostic catheters and ConcierGE? Guiding Excellence catheters with radial-specific shapes.

ConcierGE has approximately 30% more kink resistance2?and better torque response3?than the leading guiding catheter brands.

Cardiologists will now have the ability to match their guiding catheter to the shape of their diagnostic catheters, helping to reduce the need for multiple catheter exchanges.

Merit’s?Performa Ultimate? diagnostic cardiology catheters include four radial–specific shapes including the Ultimate shape, which can be used in both right and left coronary arteries using a single catheter.

ConcierGE and Performa Ultimate–more shapes give radialists more options for successful access.

Guido Sanduilli
Marketing Director
Cardiovascular Division

1?Kwan et al,?http://www.ptca.org/radial/optitorque_kwan.html
2?Data on File. Test results are based on 6F guide catheter comparison.
3?Data on file. At ? hub rotation.

InQwire? Diagnostic Guide Wire Available in Baby J Configuration To Facilitate Transradial Intervention

Manipulating diagnostic guide wires through radial vasculature can sometimes be a little more complex than the pathways used during femoral access. To help facilitate radial navigation, Merit offers its?InQwire?diagnostic guide wire in both the standard J 3.0 mm curved tip as well as a 1.5 mm smaller ”baby” J tip configuration.?The smaller, more closed J tip can help you navigate through the vasculature without selecting unwanted branches along the pathway.

The InQwire guide wire is precoated over the entire wire surface for smooth, consistent coverage that resists flaking. Smooth PTFE coating means less friction which improves trackability, lubricity, and durability. InQwire wires also have precise J-tip memory that ensures tip shape retention during utilization.

Catalog Code
Diameter
J Tip
Length
Configuration
IQ35F210J1O5
0.035″
(0.89 mm)
1.5 mm
210 cm
Standard
IQ35F210J1O5F
0.035″
(0.89 mm)
1.5 mm
210 cm
Firm
IQ35F210J3
0.035″
(0.89 mm)
3.0 mm
210 cm
Standard
IQ35F220J3
0.035″
(0.89 mm)
3.0 mm
220 cm
Standard
IQ35F260J1O5
0.035″
(0.89 mm)
1.5 mm
260 cm
Standard,
Exchange
IQ35F260J1O5F
0.035″
(0.89 mm)
1.5 mm
260 cm
Firm
Exchange
IQ35F260J3
0.035″
(0.89 mm)
3.0 mm
260 cm
Standard
Exchange

Having the right tools for your radial?procedure provides the efficiency and effectiveness that?can help ensure?a successful outcome for your patients. Contact your local Merit Sales Representative to learn more about InQwire for radial and our extensive line of products for radial approach.

Penny Goldman
Senior Product Manager