"Single Arm-Double Access" for CTO Intervention

J INVASIVE CARDIOL 2019;31(1):E7.

Key words: access site, chronic total occlusion, right coronary artery

A 78-year-old male patient with end-stage renal disease on hemodialysis was referred to our department for elective angioplasty of a right coronary artery chronic total occlusion (CTO).

Double access was decided in order to apply all options of the hybrid algorithm. The use of the left forearm as an access site was contraindicated due to the presence of a functioning arteriovenous fistula. The patient was negative to a femoral approach, so we decided to perform a “single arm-double access” approach. We inserted two 6 Fr, 11 cm-long sheaths in the right radial and ulnar arteries (Figure 1A), the guiding catheters were advanced to the ostia of the coronary arteries (Figures 1B and 1C),  and the CTO intervention was successfully performed using the retrograde technique (Figures 1D, 1E, 1F).

To our knowledge, this is the first reported case of a dual- access approach for CTO intervention using transradial and ipsilateral transulnar access. Although retrograde CTO intervention is a challenging procedure, a single arm-double access approach seems to be a feasible alternative that may be useful in patients with limited access-site availability.

From the Second Department of Cardiology, Hellenic Red Cross Hospital of Athens, Athens, Greece.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted July 24, 2018. 

Address for correspondence: Eleftherios Kontopodis, MD, 2nd Department of Cardiology, Hellenic Red Cross Hospital,  Athanasaki 1,  GR 11526, Athens, Greece. Email: ekontopodis@gmail.com