International Circulation: One serious complication of transradial coronary intervention is radial artery occlusion， so it is important to adequately assess the circulation issues in the hand before the procedure. My question is whether the Allen test is enough to assess， especially for diabetic patients.
《国际循环》：经桡动脉介入治疗的一个严重并发症是桡动脉闭塞，为此应在术前充分评估手部的血运情况。我的问题是单纯进行Allen试验进行评估是否已经足够，尤其对糖尿病的患者。
Prof. Kiemeneij: The way you addressed this question is pointing towards a serious event. I don’t think it is a serious event. Radial artery occlusions occur， but it has no consequences. You can look back in history and see the common practice in intensive care where radial arteries are cannulated for a long period of time. You have radial artery occlusion rates up to 50%--that’s existing literature， without any sequelae and without any pre-procedural testing of the collateral circulation. If you look at the practice of harvesting radial arteries for bypass grafting， you lose your radial artery anatomically completely and even that is done without any functional testing. So， I disagree with the question. I don’t think it is a serious complication. In our practice we have abandoned doing any testing at all. We don’t do an Allen test and we aren’t looking for any alternative.
Kiemeneij教授：我不认为桡动脉闭塞是一种严重的并发症，如果出现桡动脉闭塞，也不会出现不良后果。在重症监护中心持续相当一段时间的桡动脉插管是一件很常见的事情。文献报道桡动脉闭塞的发生率高达50%，没有任何后遗症，没有进行任何术前侧支循环的检查。如果你见到过桡动脉移植术，那么你就知道这时在解剖学上就桡动脉已经完全消失了，甚至是在没有进行功能测试的情况下进行手术。所以我不同意你的这种说法。我不认为这是一个严重的并发症。在实践中，我们从来不进行任何相关检查。我们不进行Allen实验，也不想寻找这种方法。
International Circulation: Sometimes Failure of PCI by transradial approach is because of inadequate catheter support， especially in complex lesions of RCA (Right Coronary Artery). At that time， how to overcome it and how to select the guide to provide the necessary guiding support during PCI.
《国际循环》：有时经桡动脉介入治疗失败是由于导管的支撑力不足，特别是进行右冠状动脉复杂病变操作时。此时PCI时应如何克服上述问题，如何选择导管以提供必要的导管支撑力？
Prof. Kimeneij: It surprises me. You are approaching the transradial approach in terms of its limitations and potential shortcomings. First of all， I don’t think there is any difference in catheter support either done by radial or femoral. It’s old history that 6 French guides have less support compared to 8 French guides. We know that is true， but today the 6 French guide is the standard， also for the femoral approach. The Judkins catheter， which is usually used for right coronary interventions， is a catheter that lacks backup with either technique. Therefore， I think you have to select better guides， and that is true for femoral and it is true for radial. If you are negotiating very complex right coronary lesions， if the takeoff is very sharp， if the lesion is very tight or long， or if you have any doubts about the crossability of the lesion， you should aim for a better support catheter. For example， the Emplex guides， multi-purpose guides， and there are also dedicated radial guides. It is not an additional shortcoming of the radial approach. It may be a problem which is inherent to any right coronary problem.
Kiemeneij教授：这个问题让我很吃惊。你是根据桡动脉介入治疗的局限性和潜在缺点选择这种治疗方法的。首先，我认为无论是经桡还是经股通路，在导管的支撑力上都没有显著的差异。与8 French导管相比6 French支撑力不好，已经是过去的事了。现在我们认为6 French导管是标准，对于经股通路也同样。右侧冠状动脉介入时使用的Judkins导管，是一种缺乏支撑的导管。所以，我认为应该选择好一些的导管，对股动脉介入和桡动脉介入同样适用。如果你处理的是很复杂的右侧冠状动脉病变，如果病变的起始部很尖锐，或是如果病变很密集或是很长，或是如果你对病变的复杂性有疑问，那么你应该寻求一种支撑力好的支架。例如，Emplex导管、多功能导管和专门用于桡动脉的导管。这并不是桡动脉介入方法的另一个缺点。这可能是所有右冠状动脉疾病均存在的问题。
International Circulation: Do you feel that sometimes people tend to emphasize potential shortcomings more with the transradial approach.
《国际循环》：您是否认为有时人们过分注重了桡动脉介入的缺点呢？
Prof. Kiemeneij: Yes. It is more used as an excuse. There is an enormous difference in the acceptance of transradial between the West and the East. Especially in the United States， there is a very low penetration of this technique and I have my explanations for it. These two questions are the typical questions that have been raised very early in the transradial era—17 years ago. If you see the cases and read the publications， these are not the issues.
There are of course， limiting issues on transradial. Transradial is not a religion. It is not something that you have to do. It is a practical solution to overcome other limitations of the standard approach. Sometimes the radial approach is not suited to a particular patient and then you must do something else. You have to balance the two techniques， but these two issues of radial artery occlusion and lack of support are not the basic limiting issues.
Kiemeneij教授：是的。东方和西方国家对桡动脉介入治疗存在巨大的差异。特别是在美国，这项技术的应用较少，我也有我的想法。这两个问题是早在17年前桡动脉介入时代就存在的典型问题了。如果你看过有关此方面的病例和文献，你就明白事实不是这样的。
当然也存在经桡动脉介入的局限性。经桡动脉介入不是一种信仰。不是必须要选择这种方式。它是克服标准术式局限性的一种实际解决途径。有时桡动脉介入可能对个别患者不适合，就必须考虑其他的治疗方法。你必须对两种术式进行权衡，但桡动脉闭塞和缺乏支撑力这两个问题不是基本的限制。
International Circulation: How do you think CIT has contributed to exchanges and cooperation between East and West? What about any Chinese contributions in transradial or other PCI?
《国际循环》：您是否认为CIT促进了东西方知识的交换和合作？在经桡动脉介入或是其它PCI治疗中中国做了哪些贡献？您是否认为CIT促进了东西方知识的交换和合作？在经桡动脉介入或是其它PCI治疗中中国做了哪些贡献？
Prof. Kiemeneij: CIT is a good example， but there are also other meetings here. There are sessions during the Great Wall meeting as well. CIT as an interventional meeting also focuses on radial approach. I think one of the important factors is that there is more training here. Interventional cardiology in China does not have as long a femoral history compared to the United States. Quite early in the development， the 6 French guides were introduced here in China. There is some unexplained favor throughout Asia for doing more complex techniques. When I started with the technique I really did not think that in Asian countries， where in general arteries are smaller， it would pick up so rapidly as here. Especially Japan， China， and now India they are really rising fast.
Kiemeneij教授：CIT是一个很好的例子，但是在中国也举行了一些其他的会议。长城会议期间也有这个议题。CIT是关注经桡动脉介入的介入学会议。我认为此次会议重要亮点是在会议中进行了更多的训练。中国介入心脏病学经股途径的历史要短于美国。在发展的早期，6 French导管就进入了中国。整个亚洲热衷于追求更复杂的术式。当我进行经桡介入研究时真的没有想到亚洲国家，对较小的动脉就可以迅速的处理。特别是日本、中国、印度的发展很快。
International Circulation: There has been a bit more openness and acceptance of the technique?
《国际循环》：目前这种技术更开放和易于采用吗？
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