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The utility of extension catheters in transradial percutaneous coronary intervention
Tak W Kwan1, Ravi Diwan, Justin A Ratcliffe
1Beth Israel Medical Center, 139 Centre St, Rm 307, New York, NY 10013 USA. Kwancardio@aol.com.
Insights
Extension catheters improve success rates for transradial intervention in complex coronary lesions, reducing the need for femoral artery crossover. This technique offers a viable solution for challenging percutaneous coronary interventions.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Vascular Access Techniques
Background:
- Transradial approach for complex percutaneous coronary intervention (PCI) presents challenges in achieving adequate guide catheter support.
- Difficulty in catheter support can hinder the successful treatment of complex coronary lesions.
Purpose of the Study:
- To evaluate the efficacy and safety of using extension catheters during transradial intervention for complex coronary lesions.
- To determine if extension catheters can improve procedural success and reduce crossover to the femoral approach.
Main Methods:
- Retrospective case series of 54 patients undergoing PCI for complex coronary lesions.
- Complex lesions defined by severe calcification, tortuosity, chronic total occlusion, or distal to a stent.
- Transradial approach with an extension catheter was the primary strategy, avoiding immediate femoral crossover.
Main Results:
- High success rate (96%) for transradial intervention using extension catheters.
- Stent delivery failure occurred in only 2 cases (severe tortuosity/calcification).
- No coronary dissections were reported due to extension catheter use.
Conclusions:
- Extension catheters facilitate successful transradial intervention in complex coronary lesions.
- Utilizing extension catheters can decrease the rate of conversion to the femoral approach.
- This technique enhances the feasibility of transradial access for challenging PCI cases.
Objectives:
To evaluate the use of extension catheters in transradial intervention of complex coronary lesions.
Background:
Complex percutaneous coronary intervention (PCI) via transradial approach remains a challenge for many interventionalists, primarily due to the difficulty in obtaining adequate guide catheter support.
Methods:
A retrospective case series identified 54 patients who presented for PCI of complex coronary lesions. A lesion was defined as complex if it contained severe calcification, proximal tortuosity, chronic total occlusion, or was located distal to a previously implanted stent. After identifying the complex lesions, a conversion to femoral approach was considered, but an attempt via the transradial approach with the use of an extension catheter was chosen as the initial strategy. Specific cases highlighting this approach are illustrated in detail.
Results:
The average age of the patients was 72 years old, with male predominance (55%). The success rate of completing the transradial intervention with the help of an extension catheter was 96%. Stent delivery failed due to severe tortuosity and calcification in only 2 cases. The coronary artery involved was either the left anterior descending (n = 25), the left circumflex (n = 10), the right coronary artery (n = 14), or a saphenous vein graft (n = 5). There were no coronary dissections evident from use of the extension catheter.
Conclusion:
In the treatment of complex coronary lesions via the transradial approach, the use of an extension catheter may assist in improving successful intervention and decrease the frequency of crossover to a femoral approach.
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