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ABS20191105_0002
| Vascular Access (transradial) | |
| Feasibility of Transradial Multi-Vessel Percutaneous Coronary Revascularization to Both Left and Right Coronary Arteries by Using Judkin's Left as a Multipurpose Guiding Catheter | |
| Fathima Aaysha Cader1, A C2 | |
| Ibrahim Cardiac Hospital & Research Institute, Bangladesh1, ICHRI, Bangladesh2 | |
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Background:
Appropriate guiding catheter selection in trans-radial percutaneous coronary intervention (PCI) is important for procedural success. Use of separate guiding catheters for multi-vessel PCI to both right and left systems requires catheter change, leading to increased radial artery spasm, patient discomfort during exchange, increased procedural time, fluoroscopy time and cost.
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Methods:
This prospective single centre study included patients undergoing trans-radial PCI of right and left systems from January 2016 to December 2018. They were assigned into 2 groups: single left-sided guide vs. separate right and left guide. Patients requiring acute ad hoc PCI to RCA first were excluded. We statistically analysed contrast volume, procedural time, radiation time and radial artery spasm between the two groups.Cannulation technique: Default access was right radial, unless right radial pulse was impalpable. Judkin¡¯s left (JL), or appropriate left sided catheter was engaged for left system PCI. After completing left system PCI, guide was disengaged, advanced to the floor of right coronary sinus, then turned clockwise while continuing to push its tip down with gentle manipulation. In some cases, a 0.035¡¯¡± wire was used to assist engagement.
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Results:
937 patients were included. 451(48.1%) were of single left-sided guide use. 486 (51.9%) had separate right and left guide use. In the single guide (JL) group, 367 (81.4%) underwent double-vessel PCI, 84 (18.6%) underwent triple vessel PCI. 41.5% underwent PCI to LAD and RCA; 39.9% underwent PCI to LCx and RCA. JL 3.5 5 French (F)catheter was most frequently used (96.1%). JL 3.5 6 F, JL 3.0 6 F and Ikari left (IL) 3.5 5 F guides were used in 1.5%, 0.9% and 1.5% respectively. Single guide catheter was associated with significantly lower procedural times (p=0.032) and radial artery spasm (0.9% vs 2.9% respectively; p=0.02), most frequently seen during catheter exchange. Contrast volume was lower in single guide catheter group. Switch-over from JL to right sided guide was 0.66%, mostly in case of CTO of RCA, necessitating better back-up support. No vascular access site complications were observed.
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Conclusion:
Except in certain exceptional circumstances, the use of JL guide as a multi-purpose catheter is a safe and feasible option for both system trans-radial PCI, resulting in lesser procedure time and reduced radial artery spasm.
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