This document discusses three cases of transradial PCI performed using a sheathless 7 French guide catheter. The first case involves stenting of multiple lesions including a left main bifurcation lesion. The second case involves stenting of a left main bifurcation lesion with a mid LAD total occlusion. The third case involves stenting of a critical left main bifurcation lesion in a female patient. The document notes that complex angioplasty can be performed using a 6 French guide but with increased procedure time and radiation. Using a sheathless 7 French guide through radial access allows for the benefits of radial access while enabling the use of a larger bore guide for complex cases.

1. Transradial LM PCI with
sheathless 7f guide
Dr Jaspal Arneja
Arneja heart institute
Nagpur

2. • 78 yr male
• HT / Diabetes
• ACS- NSTEMI
• ECG: T inversion ant lead
• ECHO : EF 45% RWMA +
• CAG Follows

3. Ramus critical lesion
Ostioproximal lad lesion with no stump
Distal LAD Flow limiting lesion

4. • Left main bifurcation lesion
• Planned for provisional LM bifurcation stenting if needed crossover
• Planned to do with radial access with 7f guide comfort

5. For Bifurcation stenting doing procedure
with 6f guide is painful
few techniques needs 7f guide only Which
is not possible with radial access due to
small diameter …

8. Ramus critical lesion
Ostioproximal lad lesion with no stump
Distal LAD Flow limiting lesion

9. Predilatation followed by stenting 2.5/28

11. Low pressure dilatation in ostial lesion High pressure dilatation in distal lesion

12. Distal LAD Lesion stenting 2.5/23 DES

13. Plaque modification with
scoring balloon for lad ostium

14. Slow flow noted a/w angina hypotension ?? Microvascular clogging ??? Dissection

15. Slow flow noted a/w angina hypotension ?? Microvascular clogging ???
Dissection?? both
Flow not improved with vasodilators … so decided to stent immediately 3.5/28 DES

16. Targeted vasodilator with thrombosuction catheter

17. POT with 4 mm NC balloon at high pressure

18. Optimisation of proximal and distal stent

19. Final result

20. Case 2

21. Clinical data
• 59 yr
• HT
• DM
• Unstable angina
• TMT positive
• EF- 55%
• CAG : suggestive of left main bifurcation lesion with mid LAD total
occlusion

22. CAG s/o LM disease with proximal LAD total
occlusion

23. • Planned for left main to LAD Provisional stenting if needed crossover
stenting to ramus

25. Lesion crossed with sion wire and passage
made with 2 mm balloon

26. Mid LAD stenting followed by left main to
LAD stenting

27. Optimisation of left main and LAD Stent

28. Post stenting result

29. Kissing balloon inflation f/b OCT

30. MLA – 9 MM2 in proximal LAD
MLA – 14 MM2 in LM

31. REPOT

32. FINAL RESULT

34. • 52 yr female
• HT
• DM
• Hypothyroidism
• CAD : S/P PTCA TO LAD LCX AND RCA 2019
• Old AWMI
• Presently effort angina CCS CLASS III
• CAG : Critical LM bifurcation lesion

35. Female obese
7f JL used with radial access as dedicated bifurcation stenting planned

36. NC balloon followed by angiosculpt balloon
for plaque modification

37. 3.5/16 DES

38. Lcx strut recrossing
and dilatation at
ostia

39. 3/13 DES

41. Final result

42. • Complex angioplasty can be done with 6f guide but at the cost of
prolonged procedure time, increased radiation time, increased
hardware
• Data shows that radial access decreases morbidity and mortality in
PCI
• This technique helps us to use large bore guide for complex
angioplasty with radial access