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Cafri C


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Bifurcation Percutaneous Coronary Intervention Using Transradial Approach

Bifurcation Percutaneous Coronary Intervention Using Transradial Approach

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  • 1. Bifurcation PCI using a Radial Approach Carlos Cafri, MD Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva , Israel
  • 2. The Case• Male, 59 years old• Family history of CAD, HTN, type II DM• Current presentation – One month of exertional angina and shortness of breath – Admitted due to recurrent chest pain and troponin elevation: NSTEMI
  • 3. The Case• Coronary angiography within 24 hours of admission – Right radial artery – 6F universal diagnostic catheter (Optitorque: 6F- BLK) – Single vessel disease
  • 4. The Bifurcation n True Bifurcation: Medina 1.1.1 Large Diagonal Branch: Large diameter: >2.5 mm Large territory n 60 ° angle between branches
  • 5. Possible Strategies• Single Vessel Stenting/ Provisional Stenting• Two Vessel Stenting
  • 6. Decision• Data – Randomized trials: Cactus,Nordic, BBC – Observational trials• Consensus – European Bifurcation Club Meeting• Feeling – “Optical-Limbic Reflex”• Access Site
  • 7. The Decision : “Access Site” – Paradigm: • “It is really hard to perform two vessel stenting via the transradial approach” • “Through the radial approach try to do provisional stenting”
  • 8. Why?• Transradial PCI is performed with 6 F guiding catheter• A 6 French guide catheter allows simultaneous crossing of: • Two balloons • Balloon and stent• A 6 French guide catheter never allows simultaneous crossing with two stents
  • 9. Non Compatible Techniques with 6FGuiding Catheter
  • 10. Our case: What could do? • Provisional Stenting – Predilate both branches – Stent implantation in the LAD – Probably side branch compromise – Stenting side branch if flow is reduced or chest pain occurs
  • 11. Our case: What could do? • Change the access site : – Femoral artery – 7 French – “Pay the price” • New puncture • Bleeding risk • Discomfort
  • 12. Our case: What could do? – 7 French guiding catheter • Possible • Selective : Men, large radial, first radial cath, no previous spasm • Complicated: Spasm, bleeding and radial occlusion
  • 13. Our case. What could we do?• Sheathless guiding catheter
  • 14. Innovations in Guiding Catheters
  • 15. Our case: What we did• Exchange 6F sheath to 7.5 F sheathless guiding• Heparin: 9000 U.• Two wires: ATW- Whisper• Kissing balloon: 2 x 15mm• Two stents delivery: Promus 2.75 x 18mm; 2.5 x 12mm• Mini-crush technique• Diagonal stent deployment• LAD stent deployment• Final kissing balloon with a non compliant balloon
  • 16. Conclusions• Implementation of 7 F. Guiding catheters or sheath less guiding catheters during transradial PCI allows simultaneous delivery of two stents.• All the existing strategies creates for the angioplasty treatment of challenging bifurcation lesions can be performed through the radial approach