#GUIDELINER CATHETER VIDEO SERIES#

The graft was then wired with a Pilot 50 wire (Abbott Vascular, Chicago, IL, USA), which allowed railroading of a 6-French GuideLiner (Teleflex Inc., Wayne, PA, USA) for selective cannulation of the LIMA ( figure 1C, video 2). Advancement of the catheter over this wire was followed by sub-selective angiography revealing the origin of the LIMA ( figure 1B). The guide catheter was withdrawn to the aortic arch and rotated cranially, allowing advancement of a 0.035 in 150 cm J-tip wire (Cordis, Milpitas, CA, USA) into the left subclavian artery. A GuideLiner extension catheter is advanced over a guidewire to allow deep seating of the LIMA. The guide catheter is rotated cranially allowing cannulation of the left subclavian artery, non-selective angiography reveals the LIMA origin. Initial coronary angiogram using the Jе…ѓ.5 guide catheter. Case 1 showing successful percutaneous coronary intervention (PCI) to the left anterior descending (LAD) via the left internal mammary artery (LIMA) graft. A decision was made at this stage to proceed to percutaneous coronary intervention (PCI) to his native LAD via the LIMA graft. This showed that the LAD was now severely diseased distal to the graft insertion ( figure 1A, video 1).

A Jе…ѓ.5 6-French guide catheter (Launcher Medtronic, Minneapolis, MN, USA) was used for native coronary angiography. His LRA had been used for grafting, therefore, the right radial artery was cannulated with a 6-French sheath. He was brought to the catheter lab for coronary restudy. His background included a previous stroke, hypertension, chronic kidney disease stage 3, hyperlipidaemia and being an ex-smoker.

Case 1ДЄ 64-year-old man presented to the cardiology clinic six years following coronary artery bypass grafting (CABG, left internal mammary artery to left anterior descending left radial artery to obtuse marginal saphenous vein graft to right coronary artery ) with increasing angina and shortness of breath refractory to medical therapy. This technique demonstrates that cardiologists do not necessarily need to resort to routine femoral access when the ipsilateral radial artery is not available.

#GUIDELINER CATHETER VIDEO SERIES#

We present a case series illustrating a simple technique for selective angiography of an IMA graft from the contralateral radial artery. Given the superior outcomes of arterial over vein graft revascularisation, 9,10 we can only assume that the number of these patients presenting for angiography will increase in the future. Although the ipsilateral radial artery provides a direct route to an IMA graft, the advantage of this route is lost when bilateral IMA grafts need to be visualised, or when the required radial artery has been used for grafting. One such traditional bastion of the femoral approach is internal mammary artery (IMA) graft angiography. Nonetheless, femoral access undoubtedly continues to remain relevant in situations such as large bore and complex intervention, the need for mechanical support devices, and structural intervention.

6,7 Even putting the preferences of transradial enthusiasts aside, it also seems that patients who have had experience of both access routes prefer use of the radial artery. While many in the interventional cardiology community consider the debate of routine radial versus femoral access for coronary angiography to be all but over, 1-5 there, nonetheless, continues to be a wide variation in the uptake of transradial access worldwide.

Guideliner catheter video