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A Q&A for Cath Labs with Physicians Performing Radial Access
Is it possible to do a complex bifurcation lesion via the transradial approach?
Yes, it is possible to do a complex lesion at a bifurcation. Following is a transradial case done 
by Dr. Zaheed Tai, treating a lesion at the left circumflex and obtuse marginal using photoablation and the kissing technique.
The patient was an 81-year-old white male, presenting as as non-ST-elevation myocardial infarction. We accessed through the right radial, upsizing to a 6 French sheath. We used an XB 3.0 (Cordis Corp., Miami Lakes, Fl.) guiding catheter. We used a Kinetix wire (Boston 
Scientific, Natick, Mass.) into the left posterior descending artery (LPDA), and then used a Runthrough wire (Terumo Medical, Somerset, New Jersey) into the obtuse marginal. Using a 0.9 Excimer laser, we made a channel using laser atherectomy at a setting of 45-25, then 60-40. With improved flow and an angiographic channel, a 2.5 by 10mm Angiosculpt balloon (AngioScore, Inc., Fremont, Ca.) was advanced over the Kinetix wire into the LPDA. We pre-dilated the ostium of the vessel as well as the bifurcation, then removed the balloon, ran it over the Runthrough wire and did the same to the obtuse marginal. At this point, there was a residual stenosis in both vessels of approximately 50%, but definitely improved flow. A 3.0 by 18 mm Endeavor drug-eluting stent (Medtronic, Inc., Minneapolis, Minn.) was advanced from the circumflex into the LPDA, covering the origin of the PDA and deployed at 14 atm. The Runthrough was removed before stent deployment. We rewired the obtuse marginal and ran a 2.5 by 15 mm Sprinter balloon (Medtronic), then advanced a 3.0 by 12 mm Sprinter on the Kinetix wire and performed kissing balloon inflation with the balloons in the proximal portion of the Endeavor. Both inflations were done at 14 atm. Post-dilation, the balloons were removed, and angiography revealed TIMI-3 flow in the circumflex artery, with no residual stenosis in the obtuse marginal or the LPDA.
Disclosure: Orlando Marrero reports no conflict of interest regarding the content herein.
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Email your question to Orlando.Marrero@WinterHavenHospital.org
by Dr. Zaheed Tai, treating a lesion at the left circumflex and obtuse marginal using photoablation and the kissing technique.
The patient was an 81-year-old white male, presenting as as non-ST-elevation myocardial infarction. We accessed through the right radial, upsizing to a 6 French sheath. We used an XB 3.0 (Cordis Corp., Miami Lakes, Fl.) guiding catheter. We used a Kinetix wire (Boston 
Scientific, Natick, Mass.) into the left posterior descending artery (LPDA), and then used a Runthrough wire (Terumo Medical, Somerset, New Jersey) into the obtuse marginal. Using a 0.9 Excimer laser, we made a channel using laser atherectomy at a setting of 45-25, then 60-40. With improved flow and an angiographic channel, a 2.5 by 10mm Angiosculpt balloon (AngioScore, Inc., Fremont, Ca.) was advanced over the Kinetix wire into the LPDA. We pre-dilated the ostium of the vessel as well as the bifurcation, then removed the balloon, ran it over the Runthrough wire and did the same to the obtuse marginal. At this point, there was a residual stenosis in both vessels of approximately 50%, but definitely improved flow. A 3.0 by 18 mm Endeavor drug-eluting stent (Medtronic, Inc., Minneapolis, Minn.) was advanced from the circumflex into the LPDA, covering the origin of the PDA and deployed at 14 atm. The Runthrough was removed before stent deployment. We rewired the obtuse marginal and ran a 2.5 by 15 mm Sprinter balloon (Medtronic), then advanced a 3.0 by 12 mm Sprinter on the Kinetix wire and performed kissing balloon inflation with the balloons in the proximal portion of the Endeavor. Both inflations were done at 14 atm. Post-dilation, the balloons were removed, and angiography revealed TIMI-3 flow in the circumflex artery, with no residual stenosis in the obtuse marginal or the LPDA.
Disclosure: Orlando Marrero reports no conflict of interest regarding the content herein.
————————————————————
Email your question to Orlando.Marrero@WinterHavenHospital.org
