How to duplicate the procedural success of coronary interventions by the radial approach: tips and tricks in the selection and manipulations of guides

In this issue of the Journal of Geriatric Cardiology, Jing et al. showed off their near perfect results of percuta-neous coronary interventions (PCI) through transfemoral approach (TFA) and transradial approach (TRA) in the elderly Chinese patients. All patients were older than 60 years of age, with an average of 67. In this interventional cardiac laboratory with high operators' expertise level, the results of PCI showed no difference on the length of time for vascular access, fluoroscopy time, procedural success and less complication for TRA. These data favoring TRA were confirmed previously in many studies. In this study, most of the guides used were the Judkins right (JR) and left (JL) with rare exceptions. The majority of the lesions were in the left anterior descending artery (LAD), with smaller number from the left circumflex (LCX) and with the lowest number from the right coronary artery (RCA). The distribu-tion between the non-LAD and LAD lesion was equal at 50/50. However, in the real world, can every operator, expe-rienced and non-experienced alike, duplicate the results of Jing et al. in his own interventional laboratories? The most difficult part of any approach is to have strong guide support, sufficient for stent advancement across the target lesion. So this editorial will discuss how to achieve the same technical results as Jing et al. and focus on the selec-tion and manipulation of guides by TRA.