Size Matters: Moving Toward a Slender Transradial Artery Approach

Combined ultrasound and angiographic guidance to facilitate transradial access procedures

“…21,22 In some patients, such as females or those with a lower body mass index or smaller body surface area, the inner diameter of the radial artery could be smaller than the outer diameter of a 6 Fr sheath. 23 In such cases, downsizing to 5 or 4 Fr sheaths [24][25][26] or using slender introducers/sheathless techniques 27,28 may be appropriate (Figure 3). The recently developed Glidesheath Slender TM introducer (Terumo, Tokyo, Japan) has a thin-wall technology that enables a reduction in the outer diameter by 1 French size, while preserving a comparatively larger inner diameter.…”

“…29,30 This approach provides easier maneuverability through smaller, calcified, or tortuous vessels and minimizes the risk of radial artery trauma, thereby increasing procedural success rate and decreasing the likelihood of bleeding complications and RAO. [23][24][25][26][27][28]31 When performing coronary angiography with 4 or 5 Fr diagnostic catheters and anticipating a complex PCI that requires at least a 6 Fr guide catheter (GC) immediately afterward, the Railway Sheathless Access System™ (Cordis Cardinal Health, Santa Clara, CA, USA) may be a practical option. This device offers the flexibility to choose between two dilators that are compatible with either 0.021˝or 0.035˝guidewires, making it suitable for insertion into all currently available commercial 6-or 7-Fr GCs, essentially transforming them into sheathless GCs.…”

“…Indeed, the use of larger sheaths can lead to discomfort and vascular damage that favors the occurrence of RAS 20 and generates the prothrombotic milieu of RAO 21,22 . In some patients, such as females or those with a lower body mass index or smaller body surface area, the inner diameter of the radial artery could be smaller than the outer diameter of a 6 Fr sheath 23 . In such cases, downsizing to 5 or 4 Fr sheaths 24–26 or using slender introducers/sheathless techniques 27,28 may be appropriate (Figure 3).…”

“…A sheathless guiding catheter system (Eaucath, Asahi Intecc, Aichi, Japan), that does not require an introducer, was developed to allow an increase in internal diameter, with a hydrophilic coating that covers the entire length of the device and reduces frictional forces 29,30 . This approach provides easier maneuverability through smaller, calcified, or tortuous vessels and minimizes the risk of radial artery trauma, thereby increasing procedural success rate and decreasing the likelihood of bleeding complications and RAO 23–28,31 . When performing coronary angiography with 4 or 5 Fr diagnostic catheters and anticipating a complex PCI that requires at least a 6 Fr guide catheter (GC) immediately afterward, the Railway Sheathless Access System™ (Cordis Cardinal Health, Santa Clara, CA, USA) may be a practical option.…”

Factors influencing the community behavioral intention for adoption of Islamic banking

“…It is also applied to identify the awareness of employees toward IB (Buchari, 2015) and also used to find out the determinants of attitude and adoption of Islamic financing among non-users (Jaffar, 2016). Similarly, TRA is applied to check out the importance of size (Villablanca and Shah, 2018).…”