In this issue, we focus on approaches to vascular access and closure, which have continued to evolve as our experience and the range of catheter procedures both change. Our offering of reviews emphasizes both coronary and large-vessel valve interventions. We also have a subfeature on medication adherence, which has become a recent focus of great interest and has obvious implications for dualantiplatelet therapy.

To begin, Omar Ali, MD, FACC; Michael Salinger, MD, FACC; Justin Levisay, MD, FACC; and Timothy Sanborn, MD, FACC, compare the benefits of the radial approach versus the femoral access route, specifically in terms of learning curve, procedure times, bleeding complications, radiation exposure, cost, and patient satisfaction.

As the use of transcatheter aortic valve replacement (TAVR) continues to increase worldwide, vascular access will be a major concern due to the possible complications and their impact on patient morbidity and mortality rates. Robert M. Bersin, MD, MPH, provides an overview on the utility of percutaneous femoral artery access and closure techniques for TAVR. However, alternative access routes are also being explored. Hunaid A. Vohra, FRCS (CTh); Rizwan Attia, MRCS; and Vinayak Bapat, FRCS (CTh), discuss the appropriate procedural settings and devices for these alternative routes, as well as the feasibility and future directions of various approaches to TAVR.

Next, Itsik Ben-Dor, MD; Nelson L. Bernardo, MD; Lowell F. Satler, MD; Augusto D. Pichard, MD; and Ron Waksman, MD, describe the micropuncture technique and cases where it might be most helpful, according to the current clinical data.

Arnold Seto, MD, MPA, FACC, FSCAI, and Mazen Abu-Fadel, MD, FACC, FSCAI, present their case for using ultrasound imaging to guide arterial access. Its ability to improve outcomes and procedural success, wide availability in most facilities, and ease of use make ultrasound guidance a prudent tool for your practice.

Ramya Smitha Suryadevara, MD, and Kimberly Skelding, MD, FACC, FAHA, FSCAI, share a step-wise approach to radial access for achieving successful outcomes in angiography and coronary interventions.

Ronald P. Caputo, MD, FACC, FSCAI, bookends our access and closure issue with a look at the vascular closure devices that are available on the market today.

In our spotlight on pharmacology, we have an article by Hiren Patel, MD; Adam Bress, PharmD; and Adhir Shroff, MD, MPH, who offer advice on how to choose the right oral antiplatelet therapy for each patient. To that end, Marie T. Brown, MD, FACP, and I explain why so many patients fail to adhere to the recommended antiplatelet therapy and ways to improve compliance.

Finally, we interview Peter C. Block, MD, regarding the current issues surrounding valvular and structural heart therapies, as well as his practice at Emory University Hospital.

As always, we strive to distill the large volume of new cardiology literature into practical and relevant reviews. Please let us know if we are achieving our goal and send suggestions for future topics.