I am  an interventional cardiologist working as assistant professor of cardiology at Lady Reading Hospital Peshawar Pakistan. My hospital is a tertiary care and the largest teaching and post graduate hospital in the province.  I poineered the trans radial interventions in this province NWFP three years ago . I have done about two thousands trans radial ( diagnostic + interventional) procedures. Four hundreds trans radial coronary interventions have been performed by me and my team so for. We have found trans radial approach very effective ,patient friendly and afer the initial learning curve of about five hundred cases now we as a team are fully experienced in performing all kind of trans radial procedures. The trans radial approach has especially gained popularity among our female patients for social reasons as female patients in our part of the world are shy and uncomfortalble with groin exposure especially to male operators. I have performed both right and left radial and ulnar procedures. I have found left radial and ulnar approach technically more operator friendly because the guiding catheter stability during PCI is much better. Moreover we less commonly need dedicated radial catheters with left approach as most of the femoral  (the commonly used ) catheters do quite well and so less flouro time, contrast amount is consumed.

Since our hospital being the largest and most buisy emergency and regular patients taking health facility of the province ,we can discharge our stable low risk coronary patients on the same day after radial diagnostic or interventional procedures thus saving prolonged hopital bed occupancy, expances. Our patient like radial approach for the above reasons.

With adequate anticoagulation during the radial procedures most of the patients have patent radial arteries after angiography . I have reused the same radial artery within 2 to 3 months for second and even third time for re do diagnostic and interventionsal purpose in certain cases (when indicated). Right and Left ulnar artery once punctured pose no additional difficulties in performing PCIs or diagnostic coronary and peripheral angiograms. I suggest that establishment of trans radial programe in USA will not only bring down the hospital costs for patients but will also add considerbly to the patient ease and quality of life.       

Dr.Hikmatullah Jan, assistant professsor of cardiology , superviosr of cardiology fellowship traininng program (FCPS cardiology)

Address for correspondance : House No.13, Street No 10, Sector C-2 , Phase No.5, Hayatabad ,Peshawar Pakistan. Tel: +92 91 5828448,  Cell : +92 333 9169011,  email: hikmat12@yahoo.com

I have completely adopted a transradial approach and it has simply been the best decision I have made in 13yrs of practice.  We do the vast majority of cases via R radial and use the Terumo line of products for diagnostic work(Jacky, Tiger, Sara) and have had to convert to a femoral approach only a handful of times.  I have expanded the technique to the L arm for patients with LIMAs, but I gotta tell you, I find them tedious and although it is not as much of an issue to "lean" over the table( I'm 6'-7"), I have concern about MY radiation exposure.  We try and position the L wrist to as close to the L femoral region, but as most radialists already know, you're frequently using a radial approach because of body habitus.  

 The Talent trial will have ZERO impact on my approach. With a single catheter technique, I challenge the fluoro times, contrast, and procedural times reported.