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The study aimed to determine the predictors of procedural failure (coronary cannulation) in patients undergoing coronary angiography ± percutaneous coronary intervention (PCI) from the transradial (TR) approach.We conducted an observational study of 20,315 consecutive patients undergoing TR angiography between 2016 and 2020. TR failure was described as inability to cannulate the coronary arteries. Univariate and multivariate analyses were performed to determine independent predictors of TR failure.Out of the study population, TR failure was observed in 365 (1.8%) patients, out of which 281 (77%) crossed over successfully to the transfemoral (TF) route and 84 (23%) to left radial access (LRA). Unsuccessful procedures were most likely seen in patients who were elderly, female, BAME background, short stature or with a history of hypertension, diabetes, and renal disease. On regression analysis, age (OR: 1.024; 95% Cl: 1.014-1.035), female gender (OR: 0.729; 95% Cl: 0.555-0.957), BAME (OR: 0.786; 95% Cl: 0.612-0.959), height (OR: 0.988; 95% Cl: 0.977-0.999), hypertension (OR: 1.510; 95% Cl: 1.147-1.987) and RRA (OR: 1.977; 95% Cl: 1.105-3.538) were independent predictors of TR failure. On further analysis, these predictors of failure were not seen from the LRA approach.This study identifies that rates of TR failure are low and that predictors of failure differ between the RRA and LRA. The difference in predictors between the 2 routes suggests that in patients when coronary cannulation is unsuccessful via the RRA then the LRA could be considered as a second access site. Further study is needed to see if in selected patient groups the LRA could be used as the first-choice access route.

Nature-based solutions are seen to benefit both society and biodiversity. However, research into their future resilience is required. Soft capping is a nature-based conservation strategy that mimics the natural colonisation of plants on top of ruined walls and reduces rates of material deterioration. To remain effective, soft capping species must be tolerant of future climatic conditions. We use the Maxent species distribution model to assess the resilience of soft capping species to low and high emission scenarios across Britain and Ireland. We assess the mid- and end-century presence probability of four native and archaeophyte species used in soft capping (Sedum album,S. acre,S. anglicumandSaxifraga granulata). Future presence probabilities were calculated using the climate models HadGEM3-GC31-LL, IPSL-CM6A-LR and MIROC6. Results suggest that current sedum-based soft caps will remain viable until mid-century with additional maintenance (e.g. watering) during droughts, although soft caps predominantly formed ofSedum albummay be prone to failure in south-eastern England. In the future, species more resilient to arid conditions may need to be preferentially selected for soft capping to ensure resilience under a warming climate. Species distribution modelling provides a useful way of predicting the future resilience of nature-based solutions.

The transradial access approach is a well-established route for coronary angiography and percutaneous intervention, given its lower complication rate over the transfemoral route. However, complications are still apparent, some of which can lead to serious injury. We report a case of delayed diagnosis of localized compartment syndrome , caused by haematoma and pseudoaneurysm formation following a radial procedure which resulted in long term disability. We emphasize the importance of early recognition and diagnosis of compartment syndrome to avoid long term sequalae.