Successful use of the five-in-six system with IVUS guided transradial renal artery stenting

In transradial renal intervention, the long distance between the vascular access and the target lesion represents a major issue. The 100 cm guiding catheter (GC) may be too short to engage the renal artery particularly in tall patients or with excessive aortic turtousity. On the other hand, with the use of 125 cm long GC, only few premounted dedicated renal stents can be used. The shaft of the stent delivery system must be 140 cm or more to be compatible with the 125 GC. However, in many renal interventions, only few more centimeters are required to give the GC the sufficient working length needed for proper engagement and back up support. For this purpose, we used the Terumo "five-in-six" system to provide the necessary extra length through the protruding part of the 5 Fr GC out of the tip of the 6 Fr GC. With the super soft distal segment of the 5 FR GC deeply intubated into the right renal artery, we had the sufficient backup support to do renal stenting with IVUS guidance. This case illustrates that the "five-in-six" system can be an alternative strategy whenever extra length or strong backup support is needed during transradial renal artery intervention.