P3582An effective manipulation method with ebu guiding catheter for left coronary artery engagement under severe subclavian arterial tortuousity during trans-radial approach

Abstract

Background/Introduction: Subclavian arterial tortuosity is one of the obstacle for left coronary intubation during right radial approach (RRA), crossover to femoral or left radial approach (LRA) are quite frequently. An effective and easy manipulate method is introduced with EBU guiding catheter (GC) in this scenario. Purpose: To introduce an effective and easy manipulate method for left coronary intubation under subclavian arterial tortuosity during RRA. Methods: There are 5 basic steps for guiding catheter manipulation. Step 1, EBU GC entered ascending aorta, above aortic sinus; Step 2: EBU GC tip automatically and naturally “re-curve” during wire withdraw (formed “J” shape); Step 3: Wire exchanged with hard tip point to the curve bottom, with GC shape hold, further advance GC to a proper position; Step 4: Clock wise twist the GC, get into left aortic sinus by the support of hard tip of wire; Step 5: Manipulate GC engaged into left coronary Results: Over 90% of annul PCI cases are RRA in our daily practice, left coronary PCI with severe subclavian arterial tortuosity account only a few (10-30/3000 per annul). With this method, most of intubation were accomplished within 3 minutes without crossover to femoral or LRA. Engagement were fine with good support and coaxial, no complications were reported. Conclusion(s): Our method is clinical safe in our daily practice, also showed time efficiency and easy manipulation. (Figure Presented).