A Q&A for Cath Labs with Physicians Performing Radial Access


Questions answered by Orlando Marrero, RCIS, MBA, Cardiac Cath Lab Director, Bostick Heart Center, Winter Haven Hospital, Winter Haven, Florida.

Email your question to Orlando.Marrero@WinterHavenHospital.org

Does your lab do any rotational atherectomy via the right radial approach?

Yes. Following is a case example. The patient was a 62-year-old female, that appeared to the emergency department (ED) as a non-ST-elevation myocardial infarction (non-STEMI). Gaining radial access through the right radial, we used a 6 French Glidesheath (Terumo Interventional Systems, Somerset, New Jersey) and a Q 3.5 Guide (Boston Scientific), and engaged the left coronary system. We did an ultrasound using an iCross coronary imaging catheter (Boston Scientific). It demonstrated a highly calcified area between two stents. We initially took a 3.0 x 10 mm AngioSculpt scoring balloon catheter (AngioScore, Inc., Fremont, Ca.) and tried to predilate the lesion; however, there was significant waste (the “dog-bone” effect) and at 20 atmospheres, the balloon ruptured. We therefore removed the balloon, advanced a second wire with an over-the-wire balloon, removed the wire and inserted a RotaWire (Boston Scientific) in the distal obtuse marginal (OM). We performed rotational atherectomy with a 1.5mm burr. Following the debulking with a Rotablator (Boston Scientific), we re-advanced the Runthrough (Terumo) as a buddy wire into the OM. We kept the RotaWire in place as a buddy wire. We then advanced a 3.5 x 12 mm Promus stent (Boston Scientific), removed the RotaWire and deployed the stent at 20 atmospheres. We post-dilated with a 3.5 x 8mm Quantum balloon (Boston Scientific) at 24 atmospheres. Following balloon dilatation, angiography revealed TIMI 3 flow in the OM and into the left patent ductus arteriosus (LPDA) without any dissections or perforations.

(Procedure performed by Zaheed Tai, DO, FACC).


Disclosure: Orlando Marrero reports no conflict of interest regarding the content herein.


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