The document describes a radial approach for interventions on the subclavian artery. It outlines the technique for using a retrograde wire and stent to treat subclavian stenosis, including pre-dilatation, wire exchange, stent landing and deployment, and final angiography results. The approach uses right and left radial access with 6F sheaths and modified guiding catheters to allow for bilateral injections and guidance. The conclusion is that the bilateral transradial approach seems well-suited for subclavian interventions and offers similar long-term results as previous techniques with added safety benefits of radial access.

1. RADIAL APPROACH FOR
SUBCLAVIAN INTERVENTION
Olivier F. Bertrand, MD, PhD
Associate-Professor of Medicine, Laval University
Adjunct-Professor, Department of Mechanical Engineering, McGill University
International Chair on Interventional Cardiology and Transradial Approach
Quebec Heart-Lung Institute
Slender Club Japan- 15 April 2017

2. • I have no conflict of interest to declare
DISCLOSURE

3. LEFT SUBCLAVIAN ANGIOPRAPHY

4. RETROGRADE PTCA 5.0 MM-5FR

5. 0.035 WIRE EXCHANGE

6. RETROGRADE STENTING-WIRE-
BASED

7. STENT DEPLOYMENT

8. FINAL ANGIOGRAPHY

9. LEFT SUBCLAVIAN ANGIOPRAPHY

10. PRE-DILATATION
• Right radial : 5F
sheath/ Simmons
catheter anterograde
injections
• Left radial: 6F sheath.
Modified LIMA guiding
retrograde injections

11. LIMA PROTECTION GUIDEWIRE
• 0.014 BMW previous to
LSC angioplasty
• Exchange LIMA
guiding by Destination
6F 90cm sheath

12. LSC CROSSING

13. STENT LANDING AND
DEPLOYMENT
7,0/29 metallic. Balloon expandable

14. STENT DEPLOYMENT AND RESULT

15. POST PCI LSC GRADIENT
Pre angioplasty
Post angioplasty

16. STUDY POPULATION
AJC 2016;118-918-23

17. PROCEDURAL DATA
AJC 2016;118-918-23

18. PROCEDURAL DATA
AJC 2016;118-918-23

19. RESULTS
AJC 2016;118-918-23

20. CLINICAL OUTCOMES
AJC 2016;118-918-23

21. LITERATURE DATA
AJC 2016;118-918-23

22. PATENCY RATE
AJC 2016;118-918-23

23. LONG-TERM FOLLOW-UP
AJC 2016;118-918-23

24. CONCLUSION
• Single access or bilateral transradial approach seems
well suited for subclavian artery stenosis or occlusion
• Current available equipment appears adequate
• Bilateral guidance and ‘guideless-technique’ is another
example of slender-type approach
• Long term results offer similar results than previous
series with brachial or femoral access with usual
additional safety benefit of radial/ulnar access