Video : Bilateral Internal Mammary Artery Graft Angiogram – Distal LAD PCI Through RIMA -Radial Approach

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Cardiology / Coronary / Pci / Case in the box

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Mr Pal. Jac
Inferior STEMI 2008 : POBA RCAII, triple vessel disease > CABG
RIMA-LAD; LIMA-Int-Marg
Mitral valvuloplasty
Stress Echo : large antero-lat+inferior ischemia. Good LVEF

TOOL BOX Trans Radial Approach
Prepared by B. FAURIE & J. AZZI

1 - Puncture

- Home made plexiglass arm board for wrist hyperextension

- Emla® cream 1H before procedure on both wrists

- Local anesthesia with 1ml of Xylocaine® 1%.

- Venous canula 20 G built in the introducer kit

- Radial cocktail injected through the sheath: verapamil 3mg, Risordan® (Trinitrine) 2mg

- IV Heparin 70 UI/kg (100UI/kg if PCI)

2 - Introducers
- Cordis RadialSource™ introducer kit available in 6.5 - 10 – 20 cm in 4F, 5F and 6F with a short 20G venous canula and either 0.014" polymer coated guidewire or 0.018" spring guidewire

- Terumo Radifocus® introducer kit available in 7 and 10 cm in 4F, 5F, 6F with venous canula and plastic 0.021" wire

- Merit Medical Prelude® available in 4F, 5F and 6F

- Terumo Extralong (25cm) hydrophilic Radifocus® introducer for coronary spasm expertise (Methergin® testing) or extreme radial tortuosity. No spasmolytic cocktail administered

- Increase introducer diameter (4 to 5F or 6 or 7F...): Terumo or Cordis femoral introducer on the 0.035" J wire in place or SheathLess guiding catheter

3 - Wires for catheters advancement

- Cordis Emerald™ .035” J spring wire 150cm

- Boston Scientific .035” J spring wire 150cm

- Cordis .035" Aquatrack™, hydrophilic guidewire if failure of .035” spring wire

- Terumo.035” Angled Glidewire Advantage™ (180cm) if failure of .035” spring wire (Terumo Glidewire®: J Tip .035”, 180cm length, Product Code #HR35183M)

- .014“Abbott Vascular BMW®, Pilot® 50 in case of extreme radial tortuosity or loops

- No need for exchange wires (210 or 260cm) if you use the hydrophilic mandrin technique : strong serum flushing with a 10cc luerlock syringe over the .035’ wire leaning against the aortic cusp

- Amplatz Extra stiff spring wire 150cm if subclavian or inominate tortuosity or calcifications for catheters exchange

4 - Catheters
A- Diagnostic :

- Coronary :

- Cordis® 4 & 5F Judkins right and left (JL 3.5; JR 4), if elderlies patients or small sized persons

- Cordis® 5F Barbeau for other patients. 1 cath for LCA, RCA and LV

- Cordis® 5F and 6F RBL 4 / RBL 5, 1 cath for LCA and RCA

- Terumo TIGER (4; 4.5; 5) for LV angiogram: 5F Angled pigtail

For Bypass:

- JR for SVG and LIMA

- AL1 and Barbeau for SVG

- Cordis Modified Mammary cath for selective injection of RIMA and LIMA via Right Radial: IM Barbeau or IM Bartorelli Cozzi

- Cordis Multipurpose 5F for GE graft

-Peripheral angiogram:

- Cordis Multipurpose 125cm for selective injections of mesenteric, renals, iliacs

- Simmons for carotids and subclavian

- Cordis Markerband pigtail 125 cm (NEW!) for pre-TAVI aortic and ilio-femoral measurement

- Cordis and Cook Medical Pigtail 125 cm 4F and 5 F

B- Intervention :
-LCA :

- Cordis® Vista Brite Tip® 5 or 6F XB 3, 3.5, 4 – JFL ST and LT

- Terumo Heartrail® II BL 3.5, 4

- Medtronic Launcher® 5 or 6 F EBU 3, 3.5 , 4

- Asahi Intecc SheathLess 6.5, 7.5 or 8.5F. PB4

-RCA:
- Cordis® Vista Brite Tip® 5 or 6F Barbeau – JFR or AL1 if more backup needed

- Terumo Heartrail® II 5 and 6 F Ikari Right or AL1

- Asahi Intecc SheathLess 6.5, 7.5 or 8.5F. AL1 or 2

- Medtronic Launcher® AR1, AR2, ALR1,2, AL1 and AL2

- Peripheral :
a: Renal, Mesenteric :
- Cordis® Vista Brite Tip® 6F LBT MP 125cm or Barbeau 125cm
- Asahi Intecc SheathLess MP 100cm (small persons)

b: Iliac: Cordis® Vista Brite Tip® 6F LBT MP 125cm

c: Carotid: Cook shuttle® or Asahi Intecc SheathLess 7.5 or 8.5F MP 100cm

5 - Specific devices

Active intubation and mother and child systems

- Terumo Heartrail® II 5 in 6 - 120cm

- Vascular solutions Guideliner® 5-in-6, 6-in-7, 7-in-8

- Abbott Vascular Wiggle® .014” wire by for increasing deliverability of stents in tortuosity and calcifications

6 - Closing devices

- Home made rolled pile of gauze with elastic adhesive tape. Good for very thin wrist

- Zoom Co Médic Hemo Stop

- Terumo TR Band™ Product Code: XX*RF06 (Regular; 24cm)

- Access Closure Bengal™ Radial compression band

- Merit Medical Finale™ compression device

- Saint-Jude Radistop™ compression assist device

Shooting date : 2011-09-02
Last update : 2021-06-09

1 comment

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Mohamed M. Good

2018-06-23, 0h54
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Bilateral Internal Mammary Artery Graft Angiogram – Distal LAD PCI Through RIMA -Radial Approach

Location: Groupe Hospitalier Mutualiste, Grenoble, France

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TOOL BOX Trans Radial Approach
Prepared by B. FAURIE & J. AZZI

Hakim Benamer

Benjamin Faurie

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Bilateral Internal Mammary Artery Graft Angiogram – Distal LAD PCI Through RIMA -Radial Approach

Location: Groupe Hospitalier Mutualiste, Grenoble, France

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TOOL BOX Trans Radial Approach Prepared by B. FAURIE & J. AZZI

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