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Sequential contralateral injection through the same transradial vascular approach in a chronic total occlusion.

Ferrer-Gracia MC, Linares JA, Ruiz JR - Postepy Kardiol Interwencyjnej (2015)

View Article: PubMed Central - PubMed

Affiliation: HCU Lozano Blesa, Zaragoza, Spain.

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Contralateral injection has been described as a useful tool in the treatment of chronic total occlusions (CTOs) to evaluate the distal segments of the occluded artery... We began the procedure treating the left circumflex artery occlusion with an EBU 3.5 6 Fr guiding catheter and an Asahi Sion “J” guidewire which crossed the occlusion easily... Then, using the same sheath, we changed to a JR 5 Fr diagnosis catheter to perform a contralateral injection... The injection from the right coronary artery showed that the guidewire was placed successfully in the marginal branch (Figure 1B)... After that we advanced the previous guiding catheter using again the regular guide in the aortic root while still maintaining the 0.014” BMW 300 cm in the marginal branch... Needing buddy-wire technique, a 2.5 × 33 mm everolimus drug-eluting stent was successfully deployed in the middle segment of the circumflex artery towards the marginal branch, and another similar 2.25 × 18 mm stent distally to the previous one (Figure 1C)... This case shows that contralateral injections are feasible through a unique puncture site using a 6 Fr sheath, a long guidewire of 0.014” placed in the endpoint branch and a 5 Fr diagnosis catheter in parallel... The 0.035” 260 cm J regular wire placed in the aortic root helps to change catheters, improving the softness of the angioplasty guidewire (and avoiding its prolapse in the coronary artery)... This looped wire allows the catheter to be turned towards the contralateral artery without disengagement of the wire... None of these three techniques can offer a real simultaneous contralateral injection... It is possible, simple and safe to perform contralateral injections using a parallel long angioplasty 0.014” guidewire and a diagnosis catheter one French smaller than the sheath... The use of one 0.035” 260 cm regular wire helps during catheter exchanges.

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A – Left main (LM) is engaged with the EBU guiding catheter. *Guidewire (0.014” 300 cm BMW Universal). B – Right coronary artery (RCA) is engaged in the ostium (RCA) with the JR 5 Fr diagnosis catheter while the angioplasty guidewire (*) remains in the marginal branch (MB). The contralateral injection shows that guidewire placement is correct. RCAs: severe stenosis at middle segment of the right coronary artery. C – Final result after stent deployment.*GuidewireLAD – left anterior descending artery, Cx – circumflex artery, MB – marginal branch, LM – left main.
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Figure 0001: A – Left main (LM) is engaged with the EBU guiding catheter. *Guidewire (0.014” 300 cm BMW Universal). B – Right coronary artery (RCA) is engaged in the ostium (RCA) with the JR 5 Fr diagnosis catheter while the angioplasty guidewire (*) remains in the marginal branch (MB). The contralateral injection shows that guidewire placement is correct. RCAs: severe stenosis at middle segment of the right coronary artery. C – Final result after stent deployment.*GuidewireLAD – left anterior descending artery, Cx – circumflex artery, MB – marginal branch, LM – left main.

Mentions: Percutaneous coronaty intervention (PCI) was performed through a 6 Fr sheath placed in the right radial artery. We began the procedure treating the left circumflex artery occlusion with an EBU 3.5 6 Fr guiding catheter and an Asahi Sion “J” guidewire which crossed the occlusion easily. However, after dilatations with a 2.5 × 15 mm balloon, no distal filling was observed (Figure 1A).


Sequential contralateral injection through the same transradial vascular approach in a chronic total occlusion.

Ferrer-Gracia MC, Linares JA, Ruiz JR - Postepy Kardiol Interwencyjnej (2015)

A – Left main (LM) is engaged with the EBU guiding catheter. *Guidewire (0.014” 300 cm BMW Universal). B – Right coronary artery (RCA) is engaged in the ostium (RCA) with the JR 5 Fr diagnosis catheter while the angioplasty guidewire (*) remains in the marginal branch (MB). The contralateral injection shows that guidewire placement is correct. RCAs: severe stenosis at middle segment of the right coronary artery. C – Final result after stent deployment.*GuidewireLAD – left anterior descending artery, Cx – circumflex artery, MB – marginal branch, LM – left main.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4495134&req=5

Figure 0001: A – Left main (LM) is engaged with the EBU guiding catheter. *Guidewire (0.014” 300 cm BMW Universal). B – Right coronary artery (RCA) is engaged in the ostium (RCA) with the JR 5 Fr diagnosis catheter while the angioplasty guidewire (*) remains in the marginal branch (MB). The contralateral injection shows that guidewire placement is correct. RCAs: severe stenosis at middle segment of the right coronary artery. C – Final result after stent deployment.*GuidewireLAD – left anterior descending artery, Cx – circumflex artery, MB – marginal branch, LM – left main.
Mentions: Percutaneous coronaty intervention (PCI) was performed through a 6 Fr sheath placed in the right radial artery. We began the procedure treating the left circumflex artery occlusion with an EBU 3.5 6 Fr guiding catheter and an Asahi Sion “J” guidewire which crossed the occlusion easily. However, after dilatations with a 2.5 × 15 mm balloon, no distal filling was observed (Figure 1A).

View Article: PubMed Central - PubMed

Affiliation: HCU Lozano Blesa, Zaragoza, Spain.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Contralateral injection has been described as a useful tool in the treatment of chronic total occlusions (CTOs) to evaluate the distal segments of the occluded artery... We began the procedure treating the left circumflex artery occlusion with an EBU 3.5 6 Fr guiding catheter and an Asahi Sion “J” guidewire which crossed the occlusion easily... Then, using the same sheath, we changed to a JR 5 Fr diagnosis catheter to perform a contralateral injection... The injection from the right coronary artery showed that the guidewire was placed successfully in the marginal branch (Figure 1B)... After that we advanced the previous guiding catheter using again the regular guide in the aortic root while still maintaining the 0.014” BMW 300 cm in the marginal branch... Needing buddy-wire technique, a 2.5 × 33 mm everolimus drug-eluting stent was successfully deployed in the middle segment of the circumflex artery towards the marginal branch, and another similar 2.25 × 18 mm stent distally to the previous one (Figure 1C)... This case shows that contralateral injections are feasible through a unique puncture site using a 6 Fr sheath, a long guidewire of 0.014” placed in the endpoint branch and a 5 Fr diagnosis catheter in parallel... The 0.035” 260 cm J regular wire placed in the aortic root helps to change catheters, improving the softness of the angioplasty guidewire (and avoiding its prolapse in the coronary artery)... This looped wire allows the catheter to be turned towards the contralateral artery without disengagement of the wire... None of these three techniques can offer a real simultaneous contralateral injection... It is possible, simple and safe to perform contralateral injections using a parallel long angioplasty 0.014” guidewire and a diagnosis catheter one French smaller than the sheath... The use of one 0.035” 260 cm regular wire helps during catheter exchanges.

No MeSH data available.


Related in: MedlinePlus