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

Author(s): 

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).

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

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