SELECTION OF GUIDING CATHETER AND TECHNICS FOR PCI IN ANOMALOUS ORIGIN CORONARY ARTERY
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1 SELECTION OF GUIDING CATHETER AND TECHNICS FOR PCI IN ANOMALOUS ORIGIN CORONARY ARTERY NGUYEN C. LOI, MD, FSCAI Vice President Vietnam Society of Interventional Cardiology
2 ANOMALOUS ORIGIN OF CORONARY ARTERY
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5 BASICS IN CATHETER SELECTION Right radial access: - Radial-designed catheter - Easier engagement in RCA Left radial access: - Femoral-designed catheter - Easier engagement in LCA
6 JL catheter for left coronary access. Use 0.5 cm smaller if right radial access. JR catheter for right coronary and vein graft access. Possible to use 1 cm larger than normal if right radial access.
7 AR catheter for downward take-off right coronary. AL catheter for upward take-off right coronary
8 Classification of anomalous origin RCA and selection of guiding catheter Kalaichelvan Uthayakumaran et al. Indian Heart J Jul; 66(4):
9 Engagement of ARCA-LSOV Type A take offs are most likely to be successfully engaged with JL catheter shapes. Kalaichelvan Uthayakumaran et al. Indian Heart J Jul; 66(4):
10 Engagement of ARCA-LSOV Type B take offs are most likely to be successfully engaged with EBU catheter shapes. (LAO Projection) Kalaichelvan Uthayakumaran et al. Indian Heart J Jul; 66(4):
11 Engagement of ARCA-LSOV Type C take offs are most likely to be successfully engaged with AL catheter shapes. (LAO Projection) Kalaichelvan Uthayakumaran et al. Indian Heart J Jul; 66(4):
12 PCI of Anomalous Right Coronary Artery Arising from the Left Coronary Cusp using an Undersized Judkins Catheter through Transradial Route Ram Awatar Rawat et al. J Clin Case Rep 2014, 4:11
13 Use of the JL Guiding Catheter in an Anomalous Right Coronary Artery with High Anterior Takeoff A very easy cannulation with avery good support was possible only using a 6Fr JL 4 diagnostic and then guiding catheter Fadil Ademaj et al. Sana Klinikum Hof, Hof, Germany
14 RCA arising from left aortic sinus. Amplatz left guiding catheter (AL 2, 6 F), floppy wire (0.0140) Satish Karur et al. ScienceDirect Journal of Cardiovascular Disease Research 4 (2013)
15 Sherpa NX balanced 3DRCA guide catheter (Medtronic) The Active version: softer distal segment allowing active engagement and reshaping in the proximal coronary artery, available in 5Fr and 6Fr sizes. The workhorse Balanced version comes in 6Fr to 8Fr sizes.
16 3DRC guide for anomalous origin of RCA from LCS
17 PCI of anomalous RCA from left sinus of Valsalva (A) Failure of usual catheters, 3DRCA guide and three wires required to visualize lesion (arrowed). (B) Post-PCI of RCA in LAO projection. Percy P. Jokhi et al. Acute Cardiac Care. 2009; 11:
18 Anomalous high origins of left and right coronary artery from left cusp AL1 guide AR II guide Saurabh Goel. JACC 65,issue 17, May 2015
19 LCX arising from a separate ostium located in close proximity in right aortic sinus JR guiding catheter (JR, 3.5, 6 F), 2 x floppy wire (0.014) Satish Karur et al. ScienceDirect Journal of Cardiovascular Disease Research 4 (2013)
20 PCI of an aberrant LCA arising from RCS (a) Non-selective CAG using a pig-tail catheter demonstrated anomalous origin of LCA and a significant occlusive lesion at the proximal left anterior descending artery. (b) JR guiding catheter, and.014 coronary long wire (c) JL guiding catheter was exchanged or superior backup support (d) No residual stenosis or dissections observed J-H Lee, J-S Park. BMC Cardiovascular Disorders.
21 DEFORMED GUIDING CATHETER
22 Non-heat deformed JL guide Chun-Chung Lin.. Acta Cardiol Sin May; 31(3):
23 PCI for Anomalous RCA arising from the LCS Chun-Chung Lin.. Acta Cardiol Sin May; 31(3):
24 Toshiki Kuno et al. DOI: / X (a) (b) RCA origin from the left coronary Cusp with midportion stenosis site (arrow), LAO and RAO view, Heat-deformed JL catheter (c) (d) Steamdeformed Judkins-left guiding catheter with use of the GuideLiner catheter to deliver stents
25 EXCHANGE GUIDING CATHETER WITH LONG WIRE
26 The difficulty in aligning catheters with the anomalous right coronary artery arising from the left sinus of Valsalva The 6 french left bypass catheter is aligned for wiring the anomalous right coronary artery. The completed result with the XB-3 guiding catheter well aligned Dazhong Sun, Douglas Bogart. Kansas City, MO, USA Case Reports in Cardiology-Volume 2012, Article ID
27 FLOATING WIRE TECHNIC
28 Cardiology Research. Volume 9, Number 2, April 2018, pages
29 AR guide and floating wire for RCA originating from LCS
30 BALLOON ASSISTED CATHETER ENGAGEMENT
31 Balloon-assisted guide catheter tracking Desabandhu V, Goyal KK, Shetty S. Heart India / Volume 5 / Issue 3 / July-September 2017
32 SUPPORTED BY MICROCATHETER, CATHETER EXTENSION, MOTHER-CHILD CATHETER
33 Anomalous Right Coronary Artery Arising from Posterior Coronary Sinus: cannulation with MP, supported by micro-catheter M.H Jim et al. Ann Acad Med Singapore 2010;39:258-60
34 - Access for PCI: right femoral artery. - Selective engagement of the anomalous RCA was unsuccessful with JR, Extra Support (XB), AR and AL catheters. - JL 3.5 guide catheter positioned just below the left coronary artery origin, - - Runthrough wire (Terumo) directed into the anomalous RCA, - GuideLiner was introduced over the wire to selectively engage the RCA ostium
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37 - Anomalous origin of Coronary arteries is challenge of angiography as well as intervention - CT coronary angiography is helpful to determine the access approach and choice of guiding catheter. Intervention: CONCLUSIONS More difficult with RCA originating from LCS: - Radial access may be used in most of cases. - Guide selection: site and take-off direction Assisted technics: - Long wire for exchange of catheter, - Anchoring technic for engagement of guiding catheter - Guide extension, microcatheter, mother-child catheter
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