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
- 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
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
-RCA:
- Cordis® Vista Brite Tip® 5 or 6F Barbeau – JFR or AL1 if more backup needed
- 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
venkatesa reddy D. VERY GOOD ATTEMPT