A novel percutaneous coronary intervention technique for chronic total occlusion: Contralateral angiography with a single guiding catheter.

We report two successful cases with a new percutaneous coronary intervention (PCI) technique to treat chronic total occlusion (CTO) by using contra-lateral coronary angiography with a single guiding catheter (GC) safely. Firstly, a GC was inserted into the coronary artery supplying collaterals and a microcatheter was inserted into the distal side of the coronary artery. Then, the GC was retroflexed and engaged in the targeted coronary artery with CTO. While the contra-lateral coronary artery was visualized by injection through a microcatheter, a guide wire was controlled and passed through the CTO lesion. Two sheaths insertion were necessary to perform contra-lateral angiography in CTO PCI. This new technique makes it possible to perform safe contra-lateral angiography with a single sheath and a single GC. It could reduce vascular access complication rates. © 2015 Wiley Periodicals, Inc.

Differences in routes of guiding catheters for left coronary artery according to access sites assessed by the combined angiography-computed tomography system.

Differences in guiding catheters (GCs) manipulations and selections among different access sites are currently unclear. We examined the differences in the routes of GCs for the left coronary artery (LCA) among the right radial, left radial, and femoral approaches. We used a combined angiography-computed tomography (CT) system that enabled to perform CT scans during percutaneous coronary intervention (PCI). We enrolled 88 patients who underwent CT scans during LCA PCI or percutaneous transluminal septal myocardial ablation. To evaluate the route of GCs, we analyzed the positions of the catheter's contact point on the contralateral aortic wall to the LCA ostium, which were expressed by the angle formed by the vertical line and the diagonal line from the GC shaft to the center of the aorta. The procedures were performed via the right radial in 47 cases, left radial in 20, and femoral approach in 21. The positions of the catheter's contact point were significantly different depending on the approaches (interquartile range - 3.7 [- 14.3 to 7.8], - 46.5 [- 76.9 to - 9.3], and - 30.7 [- 39.4 to - 22.4] degrees, respectively; p < 0.001). Multivariate analysis demonstrated that access sites and LCA ostium locations had significant impacts on the positions of the catheter's contact point. The routes of LCA GCs were different among the right radial, left radial, and femoral approaches.

Transradial intervention for chronic total occlusion at the external iliac artery using a bidirectional approach through a single guiding catheter.

A 64-year-old male with intermittent claudication due to long chronic total occlusion of external iliac artery was successfully treated with a bi-directional approach. The retrograde guidewire was inserted into the ipsilateral internal iliac artery to the distal femoral artery through a collateral channel. The procedure was performed with a single guiding catheter through a single puncture of the left radial artery. Avoid puncture of the femoral artery may be less invasive with fewer bleeding complications.

Trans-radial primary percutaneous coronary intervention in dextrocardia using double inversion technique.

Percutaneous coronary intervention in patients with dextrocardia presents several challenges due to abnormal location of the heart, mirror image pattern of aortic arch and its branches, and abnormal coronary origin and orientation. The challenges involve appropriate choice of vascular access, guiding catheters, engagement technique, acquisition and interpretation of radiological orientation of coronary anatomy, and appropriate radiological angles and views. We report a patient with dextrocardia and situs inversus who presented with acute ST segment elevation myocardial infarction and was successfully treated with trans-radial primary percutaneous coronary intervention using "double inversion technique." We also emphasize that left radial artery approach may be technically preferred to right radial artery approach due to mirror image aortic arch branching pattern. .