Video : Complex RCA Remodeling with Rotablator

It looks like you're using an obsolete version of internet explorer. Internet explorer is no longer supported by Microsoft since the end of 2015. We invite you to use a newer browser such as Firefox, Google Chrome or Microsoft Edge.

Cardiology / Coronary / Pci / SINGLE VESSEL / Case in the box

My Player placeholder

Become an Incathlab member and receive full access to its content!

You must be an Incathlab member to access videos without any restrictions. Register for free in one minute and access all services provided by Incathlab.You will also be able to log into Incathlab from your Facebook or twitter account by clicking on login on the top-right corner of Incathlab website.

Registration Login

Worldwide schedules comment Share

DESCRIPTION

88824 views

Me Val.
80 Y.O
MI : 1999 > BMS mid LAD
Family CAD +++
No symptoms
Electric positive stress test
Coro CT : Long calcified lesion of Mid RCA and Crux

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

Join the Discussion

Tuygildin A. Thank you for a wonderful event! I would like to ask to lay out cases of bifurcation stenting technique minikrash. With best wishes from Russia

2016-11-03, 17h28
Join files

Please, select your files, click upload button, write your comment and click the send button. (allowed formats : images jpeg, gif, png, and PDF)

Your browser doesn't have Flash, Silverlight or HTML5 support.

1 - Add file(s) upload

Complex RCA Remodeling with Rotablator - Radial Approach

Location: Groupe Hospitalier Mutualiste, Grenoble, France

Become an Incathlab member and receive full access to its content!

9 chapters

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

Hakim Benamer

Benjamin Faurie

Yves Louvard

Join the Discussion

Suggestions

Complex RCA Remodeling with Rotablator - Radial Approach

Location: Groupe Hospitalier Mutualiste, Grenoble, France

Become an Incathlab member and receive full access to its content!

9 chapters

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

Join the Discussion

Suggestions

Alex & The Young Generation - Ep.11

Alex & Friends - Ep.5

Advancing the standard of care with bioadaptor

Pourquoi le diagnostic des anomalies ou dysfonctions microcirculatoires est important

When to escalate and when to de-escalate

Alex & Friends - Ep.2

ML CTO 2022

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