This document discusses the transradial approach for unprotected left main PCI. It recommends the transradial approach due to its safety advantages over transfemoral access. It provides guidance on guide catheter selection for different left main lesion locations and sizes. It emphasizes avoiding ad hoc PCI and using appropriate hemodynamic support for patients with reduced left ventricular function.

1. Transradial Approach for
Unprotected Left Main PCI
Vladimír Džavík, MD
Deputy Head, Division of Cardiology
University Health Network and Mount Sinai Hospital
Professor of Medicine, University of Toronto
Toronto, Ontario, Canada

2. Disclosure Statement of Financial Interest
Within the past 12 months, I or my spouse/partner have had a financial
interest/arrangement or affiliation with the organization(s) listed below.
Affiliation/Financial Relationship Company
• Grant/Research Support • Abbott Vascular, Anthera Inc.
• Consulting Fees/Honoraria • Abiomed Inc., Astra Zeneca, Eli Lilly, Sanofi BMS
• Educational Grant • Cordis, Johnson & Johnson

3. GENERAL ISSUES
• Should PCI be the revascularization
modality?
• Why the radial access?
 Preferred access
 Severe peripheral vascular disease

4. GUIDE CATHETER SELECTION
• OSTIAL, MID-VESSEL LESIONS
 5 Fr or 6 Fr adequate
• DISTAL BIFURCATION (TRIFURCATION)
 6 Fr adequate in most cases
 7 Fr may be needed
 8 Fr may be needed rarely
• CHOICE MAY BE LIMITED BY THE SIZE
OF THE RADIAL ARTERY

5. GUIDING CATHETER DIAMETERS
* *
* NOT AVAILABLE IN THE USA

6. GUIDE CATHETER SELECTION
• OSTIAL LESIONS
 JUDKINS SHAPES ARE BEST
 AVOID ‘AGGRESSIVE’ GUIDES
• SHORT LEFT MAIN WITH A DISTAL
LESION
 SAME ISSUES
• DISTAL LESIONS
 SUPPORTIVE GUIDES ARE OK

7. RADIAL LEFT MAIN CASES

34. SUMMARY
• Transradial approach for left main PCI is
feasible and safe
• All techniques possible through the
transfemoral approach are feasible via the
transradial approach
• Avoid ad hoc PCI
• In patients with depressed LV function,
use appropriate support
 5 Fr sheath in the femoral artery
 Femoro-iliac angiogram
 Mechanical support