This document discusses catheterization techniques for accessing the left internal mammary artery (LIMA) from the right radial artery (RRA). It finds that the RRA is the dominant access site for cardiac catheterization while the LIMA is commonly used for coronary artery bypass grafting. The study evaluated different catheter types for selective LIMA cannulation from the RRA, finding success rates varied from 64-89% depending on the catheter. Skill and experience with the catheterization procedure were identified as important factors for successful selective LIMA access, along with the use of hydrophilic guidewires.

1. Imre
Ungi
Szeged,
Hungary

2. History
of
catheteriza8on
from
the
arm

4. TALENT:
Right
and
leA
access
differences
Procedure
Right
Le/
p
Diagnos5c
• Fluoroscopy
5me
(sec)
168
149
0.0025
• Dose
area
product
(Gy/cm2)
12.1
10.7
0.004
Interven5onal
• Fluoroscopy
5me
(sec)
696
614
0.087
• Dose
area
product
(Gy/cm2)
63.1
53.7
0.17
Sciahbasi
A.
EuroPCR
2010;
May
25-­‐28,
2010;
Paris,
France.

6. § Right
radial
artery
is
the
dominant
access
site
for
cardiac
cath;
§ Le/
mammary
artery
is
the
dominant
gra/
material
for
CABG.

7. Recommended
techniques/catheters
for
LIMA
from
RRA
" Louvard,
Y.
ETC
Book.
Europa;1998.
p.325
– IMA
" Kim,
MH
et
al.
CCI
2001;54:19–24
– Yumiko
" Cha,
KS
et
al.
CCI
2002;56:188
– JL,
Simmons,
modified
Simmons
" Burzo]a,
F
et
al.
CCI
2008;72:263
– JL→IMA,
upper
arm
strangula8on
" Dato,
I
et
al.
Cardiovasc
Revasc
Med
2011
– JR
diagn
→JR
guiding

8. JL
catheter
for
LIMA
angiography

9. Simmons
catheter
for
LIMA
angiography
Cha,
KS
et
al.
CCI
2002;56:188

10. Modified
Simmons
catheter
for
LIMA
angiography
Selec5ve:
89%
Cha,
KS
et
al.
CCI
2002;56:188

11. Yumiko
catheter
manipula5on
Selec5ve:
64%
Semiselec5ve:
25%
Non-­‐selec5ve:
11%

12. JR
catheter
for
LIMA
angiography

13. IMA
catheter
for
LIMA
angiography

14. Subselec8ve
LIMA
angiography

15. Subselec8ve
LIMA
angiography

16. RIMA
and
LIMA
cannula8on
with
IMA
catheter

17. Advancement
of
JR
catheter
in
the
leA
subclavian
artery

18. LIMA
stent
implanta8on
from
RRA
access

19. LIMA
angiography
through
subclavian
tortuosity

20. Conclusions
" LIMA
from
the
RRA
is
a
feasible
approach;
" Different
catheters
are
available
(or
can
be
manufactured)
for
successful
selec8ve
cannula8on;
" Skill
(ie.
volume)
is
more
important
than
a
dedicated
catheter,
and
this
can
be
the
key
of
the
success
even
with
conven8onal
catheters,
as
well.

21. However
hydrophilic
guidewires
are
indispensable...