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Updated: Aug 5, 2026
10:28
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Radial Access Strategies: Focus on Coronary Function Testing for Angina With Nonobstructive Coronary Arteries
Nathaniel R Smilowitz1,2, Samit M Shah3,4, Douglas E Drachman5
1Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York.
Summary
Transradial access for coronary function testing (CFT) is feasible and safe, even without routine radial vasodilators. Strategies ensure diagnostic accuracy for angina mechanisms in nonobstructive coronary arteries.
Area of Science:
- Cardiology
- Interventional Cardiology
- Diagnostic Procedures
Background:
- Coronary function testing (CFT) evaluates angina mechanisms in nonobstructive coronary arteries.
- Common causes include coronary microvascular dysfunction, vasospasm, endothelial dysfunction, and myocardial bridging.
- Transradial access offers benefits but presents challenges, especially in female patients, due to spasm and crossover risks.
Purpose of the Study:
- To review strategies for successful radial-first CFT.
- To maintain diagnostic fidelity while utilizing transradial access.
- To optimize patient selection and procedural techniques for radial access in CFT.
Main Methods:
- Review of techniques for radial-first CFT.
- Strategies include conscious sedation, left radial access, and atraumatic catheter/wire techniques.
- Utilizing pressure-mediated vasodilation and selective short-acting vasodilators when necessary.
Main Results:
- A cocktail-free radial-first strategy is achievable for most CFT procedures.
- Withholding prophylactic radial vasodilators is preferred for elective CFT.
- Ad hoc CFT may benefit from a pragmatic approach to radial vasodilators.
Conclusions:
- Radial-first CFT is feasible and can maintain diagnostic accuracy.
- Careful technique and selective vasodilator use are key.
- Access site selection should consider anatomy and patient preference.
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01:11Assessment of radial pulse
Assessment of Radial Pulse
The radial pulse, located at the wrist, is often the preferred site for assessing peripheral pulse because of its accessibility and dependability. The process of determining the radial pulse involves several steps:
The radial pulse, located at the wrist, is often the preferred site for assessing peripheral pulse because of its accessibility and dependability. The process of determining the radial pulse involves several steps:
01:25Assessment of apical radial pulse
Apical-Radial (A-R) Pulse Assessment
The A-R pulse assessment involves simultaneous evaluation of the apical and radial pulses. When the apical and radial pulse rates vary, this assessment helps identify a pulse deficit.
Pre-Procedural Preparation
The A-R pulse assessment involves simultaneous evaluation of the apical and radial pulses. When the apical and radial pulse rates vary, this assessment helps identify a pulse deficit.
Pre-Procedural Preparation