Salvatella N - AIMRADIAL 2014 Technical - Improve support
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This document discusses various techniques for improving support during transradial catheterization procedures, including using guide catheters with backup support, extra-support guidewires, buddy wires, larger 7-8 French guide catheters, anchoring balloons placed in branches, deep intubation of guide catheters, and guide catheter extensions. It provides guidance on how to select the appropriate technique based on the vessel accessed and level of support needed.
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Salvatella N - AIMRADIAL 2014 Technical - Improve support
- 1. How to improve support in transradial approach Neus Salvatella Hospital del Mar, Barcelona, Spain
- 2. RRA vs LRA vs FA modified from Patel
- 3. RRA vs LRA vs TFA and aorta shape
- 4. How to improve support ACTIVE SUPPORT PASSIVE SUPPORT Guide catheter with back-up support Extra-support GW, buddy-wire 7-8 Fr guide catheters Anchoring balloon Deep intubation Guide catheter extension
- 5. How to improve support ACTIVE SUPPORT PASSIVE SUPPORT Guide catheter with back-up support Extra-support GW, buddy-wire 7-8 Fr guide catheters Anchoring balloon Deep intubation Guide catheter extension
- 6. GC with good back-up support: LCA JL provides poor back-up support
- 7. GC with good back-up support: LCA JL provides poor back-up support Extra back-up curves provide > support JL: TRA vs TFA JL vs Extra Back-up
- 8. GC with good back-up support: LCA Use the longest extra-backup that fits EBU 3 EBU 3.5 EBU 4 EBU 4.5
- 9. GC with good back-up support: LCA AL2 sometimes useful, especially for LCX
- 10. GC with good back-up support: RCA AL provides more support than JR
- 11. How to improve support ACTIVE SUPPORT PASSIVE SUPPORT Guide catheter with back-up support Extra-support GW, buddy-wire 7-8 Fr guide catheters Anchoring balloon Deep intubation Guide catheter extension
- 12. Anchoring balloon Choose a branch that is unlikely to cause ischaemia Choose an 1:1 balloon and keep it inflated at low pressure
- 14. How to improve support ACTIVE SUPPORT PASSIVE SUPPORT Guide catheter with back-up support Extra-support GW, buddy-wire 7-8 Fr guide catheters Anchoring balloon Deep intubation Guide catheter extension
- 15. Deep intubation with JR Push while rotating clockwise LOOK AT: proximal vessel, pressure
- 16. Deep intubation with JR
- 17. Very deep intubation with JR
- 18. Very deep intubation with JR
- 19. How to improve support ACTIVE SUPPORT PASSIVE SUPPORT Guide catheter with back-up support Extra-support GW, buddy-wire 7-8 Fr guide catheters Anchoring balloon Deep intubation Guide catheter extension
- 20. Guide catheter extension 2 systems: - Mother & child 5 in 6: 120 cm straight 5F GC. OTW - Guideliner (5in6, 6in7): 150 cm. RX.
- 24. Guide catheter extension “Peripheral anchoring” to advance the 5in6
- 25. Deep seating GC + GC extension
- 26. Summary 1. Just tortuosity? Is a buddy wire or extra-support wire enough? 2. Would an Amplatz help? Is there a suitable branch for anchoring balloon? 3. Can I deeply intubate with my GC? 4. Do I need 5 in 6? 5. Do I need to upsize my catheter? 6. Do I need second attempt via left radial or femoral?
- 27. Thank you very much
Notas do Editor
- STEMNI, prox LAD occlusion JL GC gets out of the LM ostium when advancing thromboaspiration cath
- Place of contact on the contralat aorta is differente from R vs F: less stable, less backup support The area of contact on the contralat aorta is larger for XB, therefore XB generate greater backup force than JL
- More difficult to manipulate > Risc of damaging LM
- AL 0.75 usually fits from TRA. Increased risk of damaging prox RCA.
- Feasible if RCA has ccod caliber and No significant disease
- When using 5in6. BE CAUTIOUS WITH: PRESSURE. AIR EMBOLISM. Guideliner prev generation: vessel dissection , stent dislodgement
- Long calcified lesion on LAD. Good back up support (EBU4). BHW as buddy wire. Sould not reach the most calcified part of the plaque