Friends,

TRICO 2010, the Sixth International Transradial Intervention Course was held on October 30th and 31st, 2010. First five TRICOs were traditionally held in the month of January since 2005. However, because of some compelling reasons, it was not possible for us to organise it in January this year and after a lot of brain-storming, ultimately, it was decided to plan it on the said dates.

We started preparing for it from beginning of February 2010 onwards. Hotel bookings were done by the end of March 2010. We decided to do the live cases from SAL Hospital, and transmit them to the time tested and world-class Nirma University Auditorium.

The transradial approach should be the approach of choice for the vast majority of coronary angiographies and interventions.

Apart from Dr. Saito, we approached Yves Louvard of France, Josef Ludwig of Germany, Mitchell Krucoff of U.S.A, Kimberly Skelding of U.S.A. and Ian Gilchrist of U.S.A. All of them generously considered our offer to be on the international guest faculty. Samir Pancholy of U.S.A., John Coppola of U.S.A. and Tak Kwan of U.S.A. stood by me like true friends and accepted my invitation without hesitation. Kintur Sanghvi of U.S.A., Tejan Patel of U.S.A., Sasko Kedev of Macedonia and Surya Dharma of Indonesia were also the new additions to our international guest faculty list. We invited a mix of senior as well as young cardiologists on the national guest faculty.

We floated the first announcement in May 2010 and from July 2010 onwards we started registering the participants. By October 15th, 2010, we registered 457 cardiologists including 36 from different countries including Poland, Malaysia, Indonesia, Bangladesh, Yemen and Sri Lanka. From India, practically from every place there was representation that included from Srinagar to Thiruvananthapuram and from Shillong to Mumbai. We kept 40 spots for the cathlab nurses and technicians and were filled immediately. For the first time, in six years, we had to refuse 64 registrations considering the capacity of the hall.

Everything was well set and well organized upto a week before the course. I was deeply pained and shocked to hear from Dr. Saito that he will not be able to participate for TRICO 2010 because of his busy schedule between two hospitals and pressure of work and other commitments. Dr. Saito has been my mentor for TRA and a personal friend since almost 15 years. He has always shown his commitment and solidarity towards the development of this course and personally to my friendship. During first five TRICOs, he has remained course director alongwith me and Sanjay and astonished the audience with his terrific performance of very difficult live cases. I could not imagine this course without him. However, I made-up my mind and prepared myself alongwith Sanjay to go-ahead without him.

On 29th of October, 2010, we received all our esteemed international guest faculties. The participants also started arriving from afternoon onwards. I had received whole hearted support from the industry both pharma as well as interventional product companies. We had a team of volunteers from the industry led by Mr. Dhanvant Shah, who managed the logistics very efficiently. This included receiving the guests from the airport, arrangement for their dinner, their transport and hotel accommodation. My Secretary, Shanthi Sarvagyam and my personal staff Yash Soni worked tirelessly for almost two months. They were supported by my office staff. All these are the players behind the screen without whom the show would have been unmanageable.

Like every year, I invited the international guests at my home for the dinner on 29th evening. Everybody was happy and relaxed, so was I. We dispersed at 10.30 p.m. to have good night sleep and to prepare for next morning. At 3.00 a.m. early in the morning, I received a phone call from Nirma Auditorium that there was some technical snag and they were not able to receive optimal audio as well as video signals from SAL Hospital. I was informed that the technical team was trying their level best to fix up the problem by early morning. However, it was very tense situation for me because it happened for the first time in six years. Without losing the hope, I started working for a fall-back plan, which consisted of many additional lectures and a long panel discussion. I finished it at 6.30 a.m. in the morning. At 7.00 a.m., I received a phone call from the technical team that instead of two screens, they have been able to fix one screen and they will be giving me picture-in-picture proposition on one screen. I was quite relieved and thanked god.

I alongwith my team, reached SAL Hospital at 7.30 a.m. because we were supposed to start sharp at 8.45 a.m. We lined up 23 complicated coronary as well as peripheral cases to be shown live during these two days. As always my colleague and course director Sanjay Shah stood by me like a rock. I received unparallel support from my course co-ordinators including Chirayu Vyas, Leena Shah, Rajni Radadiya, Keith Fonseca, Biren Gandhi and Anand Jethwa during tense situations. My secretary, Geeta Trivedi alongwith cathlab nurses, technicians and attendants also worked very hard for the arrangements inside and outside the cathlab. The Chairman of SAL Hospital, Rajendra Shah, alongwith medical director, Nitin Shah and their team extended whole-hearted support for the success of this event.

Sharp at 8.40 a.m., I gave welcome address to the audience and started with my first case of a complex bifurcation LMCA alongwith multi-vessel case with calcified left system. We demonstrated rotational atherectomy and T-stenting in LMCA successfully. We also evaluated the result by IVUS. The case was moderated by Samir Pancholy, John Coppola and Kimberly Skelding very nicely. There was a lot of fruitful discussions regarding different strategies between us, panel and participants. Sanjay helped me very efficiently for successful completion of this difficult case. Yash Soni deserves personal thanks for managing technical aspects of IVUS and rota so well.

Second case was a bifurcation RCA. It was done very elegantly by Yves Louvard. He was assisted by Chirayu Vyas. I strongly feel that Yves is the best bifurcation guy in the world. I learnt his technique and adopted it for all my bifurcation cases. He is a very confident and a practical operator. Audience learnt a lot from him.

Mitchell Krucoff delivered an elegant talk onTRA: is US ready? which was very well received. Mitchell does not need any introduction.

The third live case was a mid-LAD CTO (heavily calcified). I alongwith Sanjay started the case. We encountered so many difficulties. We tried with 1.25 rota burr several times and balloon dilated the lesion. The flow was established. However, we could not negotiate the stent. There was continuous discussion between us and the panel consisting of Ian Gilchrist, Josef Ludwig and Tejan Patel. The national guest faculties also participated alongwith the audience. Although it was not a complete result, there was a great learning throughout for everybody. I am sure, everybody enjoyed the case.

The fourth live case was done by Tak Kwan and was assisted by Chirayu Vyas. It was a CTO of mid-LAD. As usual, Tak did excellent demonstration of his technique and successfully performed the case.

Following that I delivered my talk Difficulties encountered during TRA. I have seen them all, which was well received. Because we were running short of time, I planned Samir Pancholy talk Radial artery occlusion : Optimizing the issues back-to-back. He did a great job. He has done original work on this issue, which is well known internationally.

Kintur Sanghavi who was trained by us and John Coppola for TRA and who represented international guest faculty volunteered a great job of interviewing all the international guest faculties one-by-one. Saket Singhi helped him throughout.  These interviews will be delivered on the website soon. My special thanks to both of them.

We had a lunch-break between 1.30 to 2.15 p.m.

In post-lunch session, the first case was done by Yves Louvard alongwith Chirayu Vyas. It was a difficult LMCA-LCX-OM trifurcation case. He did an excellent job. He also showed final result using IVUS.

The next case was a tight OM lesion with a very sharp angle from LMCA to LCX. It was done by John Coppola alongwith Sanjay Shah. John is a very experienced operator and is known for his simplistic approach. He did a good job, which was confirmed by IVUS.

The third case was a tight LAD and a border line LCX lesion. It was done by Samir Pancholy with Sanjay Shah. Samir is known for his scientific and perfectionist approach. He did a good job on LAD. IVUS examination for border line LCX lesion was a great learning experience for the audience. Samir discussed different aspects of IVUS examination and its clinical utility in this type of cases. Mitchell Krucoff, Ian Gilchrist and Kimberly Skelding also shared their views and experience.

Following that Kimberly Skelding delivered a talk on Complications of TRA, which was well received. Josef Ludwig shared his experience TRA for AMI interventions, which was also well received.

The fourth post-lunch case was a complex right ICA stenosis, which we planned to address through left TRA. Sanjay helped me in this case. We specially invited Sasko Kedev (who is a transradial carotid expert) on the panel. We completed this procedure successfully and received some excellent comments from Sasko. For the first time we used emboshield protection device. The audience enjoyed this case.

The post-lunch fifth case was a long CTO (11 years old) of RCA, which was done by me and Sanjay. There was a lot of discussion during this case, particularly between me and Tak. It went on for more than an hour. We successfully addressed it and reconstructed the RCA using three stents. Again, there was a great mix of interaction between the operators, the panel and the audience. It was very tiring, but, extremely enjoyable experience for all of us.

This was the end of the first day. We had excellent gala dinner at Karnavati Club Lawn at night and dispersed at 11 p.m.

Second day, we started at 9.00 a.m. with the first case of LAD diagonal complex bifurcation lesion. Yves Louvard was assisted by Chirayu Vyas. Yves made this difficult case look very easy. End result was excellent.

Second case was done by me alongwith Sanjay. It was a critical osteal and body LMCA stenosis. We did rotational atherectomy and stenting and result was confirmed by IVUS. Mitchell did on-site moderation and gave some very valuable comments.

Following that, Ian Gilchrist delivered a superb talk on Right heart catheterization through upper limb vein, which was very new and extremely informative to the audience.

The third case was a failed CTO of LAD. I alongwith Sanjay did this case. We tried all different tricks to enter the true channel, but we failed. There was a lot of discussion during this case. Although we failed, it was a great education for all of us.

The fourth case was a bilateral iliac and bilateral superficial femoral artery stenosis, which was done by Sanjay Shah and was assisted by John Coppola. Use of radial approach for addressing infradiaphragmatic lesion was demonstrated in a very elegant manner.

The fifth case was an RCA bypass graft (two tight lesions in SVG). It was done by me alongwith Sanjay. We had lot of difficulties in deploying distal protection device. However, end result was excellent. Again, there was lot of exchange of ideas during this case and it was very well received. I was touched by the involvement of the audience as there was a lunch break between 1.30 and 2.00 p.m. and the case continued till 2.15 p.m. Nobody from the audience moved out for the lunch. We postponed the lunch and gathered at the auditorium at 3.00 p.m.

Post-lunch talk on Ask the experts from www.transradialWORLD.com  was delivered very well by Mitchell Krucoff. He stimulated the audience to participate very actively in this forum.

Second talk was from Sasko Kedev on Radial and ulnar approach for carotid stenting.  He probably has the largest experience on this subject. His talk was superb. I personally liked it very much. I was very impressed to see his last slide of thanks showing him standing on the peak of Mount Everest. I was very impressed as he is probably the only cardiologist in the world to do this adventure.

Sanjay Chugh from Delhi delivered a nice talk on left radial approach for coronary interventions. Following that, we had an angio discussion session which went on upto 5.00 p.m. At 5.00 p.m., I delivered concluding remarks and it was an end of one more successful TRICO.

TRICO 2011 will be held on 15th and 16th of October, 2011. In coming months, we will be providing further information on this website. I sincerely thank from bottom of my heart to everybody who helped us making this purely educational venture successful once again. If by chance, I have forgotten to acknowledge the important work of anybody, I apologize for the same.

Tejas Patel
Course Director