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5F in 6F (7F) technique in DES era (Parent-child catheter technique)

5F in 6F (7F) technique in DES era (Parent-child catheter technique). Kyoto 2 nd Red Cross Hospital, Japan Naoto Inoue M.D. FJCC FSCAI. Key Points in DES era. Simple procedure is recommended Debulking device plays a small role except calcified or bifurcated lesion

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5F in 6F (7F) technique in DES era (Parent-child catheter technique)

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  1. 5F in 6F (7F) technique in DES era (Parent-child catheter technique) Kyoto 2nd Red Cross Hospital, Japan Naoto Inoue M.D. FJCC FSCAI

  2. Key Points in DES era • Simple procedure is recommended • Debulking device plays a small role except calcified or bifurcated lesion • Safe DES implantation is important

  3. For the DES delivery • Longer is better → 23, 28, 33mm stents are • frequently used • The deliverability of long stent is not good especially in the calcified or tortuous lesion • We need the technique for the safe DES delivery

  4. 1 Catheter selection RCA: Amplatz, Hockey, Champ LCA: XB, EBU, Amplatz

  5. 6F EBU catheter

  6. 2 Pre dilatation ,pre debulking Enough predilatation (high pressure, large balloon) Rotablator (calcified lesion）

  7. Buddy wire, Support wire 5F in 6F guiding technique Large size guiding catheter Anchor technique Strong guide cathe, enough pre dilatation, debulking failed

  8. Anchor technique Side branch anchor Peripheral anchor

  9. Conquest guide wire pass But balloon cath. could not pass Cross of balloon catheter LCX guide wire 2.5mm balloon dilatation LAD CTO

  10. Cross of balloon catheter 1.5mm balloon pass the lesion

  11. 5F in 6F(7F) technique 6F mother cath. (Heartrail Terumo Co.) 6F>0.070 inch (Launcher, Heartrail Radiguide) 5F child cath. (20cm longer than mother cath. Terumo Co.)

  12. 5F in 6F technique Hemostatic valve Hemostatic valve Yconnector Heartrail 5Fr straight Y connector Heartrail 5Fr straight Heartrail 6Fr Heartrail 6Fr Hemostatic valve not good

  13. 5F in 6F technique dissection G.C.: 6F Heartrail JL 3.5 G.W.: BMW wire S670 could not cross the lesion

  14. Balloon cathe. Guidewire 5F cathe. 6F cathe. Balloon cathe. Advanced child cathe. 5F in 6F technique

  15. 5F in 6F technique During stenting Post stenting Child catheter Child catheter Child catheter Child catheter Child catheter

  16. 6Fr 5Fr distance Artery model

  17. 160 140 120 100 Resistance[gf] 80 5F in 6F 60 ６Fr only 40 7Fr only 8Fr only 20 0 0 5 10 15 20 25 Distance from 6F guiding catheter tip[mm]

  18. RCA tortuous calcified lesion HD patient

  19. Two step 5 in 6

  20. Method of 5F in 6F

  21. Alternative 5F in 6F (7F) technique Child catheter goes across the stenotic lesion No risk of stent dislocation No risk of DES polymer peeling off

  22. CABG (LITA→LAD, SVG→PL) Hemodialysis 50 y.o. male

  23. Child catheter 狭窄部位

  24. 2.5x18mm Cypher 3.0x13mm Cypher

  25. 直後 慢性期

  26. Complication • Vessel injury • Air embolism

  27. Vessel injury

  28. Air embolism • We have one air embolism • Air embolism will occur when child catheter is wedged • or angiography after stent deployment

  29. Safety use for 5 in 6F technique • Gently advancement of child catheter into the coronary • artery • Careful monitoring distal coronary pressure • Check the blood back flow from Y-connector just after • stent deployment

  30. Thank you !!

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