Transradial intervention (TRI) training for physicians in Latin America conducted through public–private partnership to contribute to improved patient quality of life and reduced healthcare expenditures

Transradial intervention (TRI): percutaneous coronary intervention via the radial artery in the wrist

TRI’s Contribution to Patient Quality of Life and Reduced Medical Spending

Top 10 Global Causes of Death, 2016

Source: Global Health Estimates 2016: Estimated deaths by age, sex, and cause, World Health Organization, 2016

According to a survey*1 by the World Health Organization, of the 56.9 million deaths around the world in 2016, the leading cause of death was ischemic heart disease, such as angina pectoris and myocardial infarction. These diseases claimed the lives of 9.4 million people and accounted for 17% of deaths in that year. Percutaneous coronary intervention (PCI) using catheters is a widely used method of treating ischemic heart disease.
A common PCI procedure used to treat ischemic heart disease is transfemoral intervention (TFI), which entails inserting catheters through the femoral artery in the groin. Recently, however, the use of TRI, a procedure in which catheters are inserted through the radial artery in the wrist, has become more common out of consideration for its ability to contribute to higher patient quality of life and reduced medical spending. TRI does not require hemostasis procedures around the groin, and patients are generally able to walk sooner after TRI procedures than after TFI procedures, resulting in shorter hospital stays. Furthermore, the rate of bleeding complications at the site of catheter insertion after procedures is said to be lower, and a U.S. clinical study*2 has indicated that the cost of TRI is roughly ¥90,000 less than TFI per procedure.

Promotion of TRI Use in Various Countries through Product Development and Training

TRI Procedure(Accessing lesion site in coronary artery via wrist blood vessel)

Although TRI boasts these benefits, it is also more difficult to perform than TFI as it can be hard to insert catheters into the narrow blood vessel (radial artery) and the access to the coronary artery is tortuous. Terumo is seeking to remove these obstacles by developing and supplying refined and improved devices for use in TRI procedures. At the same time, we are working together with highly talented Japanese physicians to develop training programs and educational tools while creating opportunities for techniques to be transferred between physicians. We thereby aim to spread understanding of the value of TRI along with the techniques for performing this procedure. As a result of these ongoing efforts, the percentage of PCI procedures for ischemic heart disease represented by TRI has been found to be around 90% in China, 70% in Japan, and 40%–50% in Asia and Europe. Moreover, the rate of use of this procedure has risen to roughly 35% in the United States, despite being less than 10% a decade ago.*3

Support for Spreading TRI in Latin America through Public–Private Partnerships

The spread of TRI in Latin America has been slower than in other regions, despite ischemic heart disease rating high among the causes of death in this region. Actual rates of usage varied from country to country but were estimated to range from 10% to 30% five years ago.*3 Medical infrastructure is being installed in these countries as their populations grow and age, but there is still a lack of equipment and physicians, creating a need for efficient, low-cost medical services.
To address this issue, Terumo is supporting the spread of TRI in Latin America through public–private partnerships to contribute to improved quality of life for patients, higher medical efficiency, and reduced medical costs. In 2011, Terumo together with Japan International Cooperation Agency (JICA) invited five young physicians from Mexico to Japan to undergo TRI training. This training was performed through cooperation with Dr. Shigeru Saito of Shonan Kamakura General Hospital, a leading authority on TRI in Japan who actively promotes the spread of TRI around the world. In addition, we participated in a public–private partnership project organized by JICA over a two-year period beginning with 2014, during which we provided TRI training for approximately 40 physicians from national hospitals in Mexico, Colombia, Brazil, and Argentina. In these training programs, physicians were invited to Japan to observe procedures at hospitals including Shonan Kamakura General Hospital and to take part in simulation training at the Terumo Medical Pranex comprehensive medical training facility. Follow-up training was also held in the respective countries of participants upon their return to check their level of proficiency at performing TRI procedures. Post-program surveys indicated a large increase in the number of TRI procedures performed at the hospitals with which participants were affiliated along with a boost in the portion of PCI procedures represented by TRI. These results confirmed a steady rise in the understanding and use of TRI. Terumo anticipates that the physicians who took part in this training program will help train other physicians in their countries as instructors.
Recognition for this program has led to its evolution into the Project for Promotion of Minimally Invasive Techniques Focused on TRI Method, a technical cooperation project that was part of Japan’s official development assistance and was promoted by JICA. Launched in 2015, this project is being advanced by the Japanese and Mexican governments. One facet of this project included the establishment of a TRI training center inside the National Institute of Cardiology of Mexico, which was completed in July 2016. Terumo is supporting this project through the provision of training apparatuses and technical instruction.

Further Promotion of the Spread of TRI through Collaboration with Various Countries’ Governments and Other Organizations

Latin American physicians undergoing TRI training

Terumo plans to continue to collaborate with medical institutions, academic associations, and government bodies in various countries to promote the spread of TRI. Through the ongoing provision of the products and training support necessary based on the circumstances and issues faced in medical settings in each country, we hope to help disseminate high-quality features.

  • *1

    Source: Global Health Estimates 2016: Estimated deaths by age, sex, and cause, World Health Organization, 2016

  • *2

    Source: Amin AP, House JA, Safley DM, et al. Costs of transradial percutaneous coronary intervention. JACC Cardiovasc Interv. 2013. (U.S. dollar amounts translated at the rate of ¥110 to US$1)

  • *3

    Percentage of PCI procedures represented by TRI in each country or region estimated by Terumo Corporation

Comment from the Associate

Naofumi Okajima

Manager, Innovation Marketing
Terumo Interventional Systems
Division, Cardiac and Vascular
Terumo Corporation

Through a JICA public–private partnership project, we worked toward the lofty goal of resolving the medical issues faced in four Latin American countries by spreading use of TRI. To this end, we offered a training program that included hands-on training using models as well as opportunities to observe the masterful techniques of Japanese physicians and to speak with these individuals. I am confident that this experience deepened participant understanding of TRI and the techniques needed to perform it. Surveys conducted after the program showed a drive to use these techniques in clinical settings in all countries, something I would say represents a massive success. I hope to help contribute to the spread of TRI through public–private partnerships with medical institutions, academic associations, and government bodies going forward. It is our goal to tie such efforts to improved health for people, lower medical costs, and consequently business growth for Terumo.