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Liu Xuebo Li Chenguang Department of Cardiology, Zhongshan Hospital, Fudan University ,

Use of Child guiding catheter in Percutanenous Coronary Intervention for right coronary artery ostial anomalies. Liu Xuebo Li Chenguang Department of Cardiology, Zhongshan Hospital, Fudan University ,. Case. Female ， 80years old “Persistent chest pain for 2 day”,

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Liu Xuebo Li Chenguang Department of Cardiology, Zhongshan Hospital, Fudan University ,

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  1. Use of Child guiding catheter in Percutanenous Coronary Intervention for right coronary artery ostial anomalies Liu Xuebo Li Chenguang Department of Cardiology, Zhongshan Hospital, Fudan University,

  2. Case • Female，80years old • “Persistent chest pain for 2 day”, • ECG：II、III、avF ST-segmentelevation，V1-6 ST-segmentdepression ，III、avF abnormal Q wave； • cTnT：0.609ng/ml，CK-MB 96U/L， NT-proBNP 1525pg/ml， • Risk Factors：HBP for over 30years；Hyperlipidemiafor 3years； DM for over10years。

  3. CAG—Left Coronary Artery RAO 30°+CRA30° RAO 30°+ CAU 30° Transradial artery 6F arterial sheath Diagnostic catheter: Tiger(5F , Terumo Japan)

  4. CAG—Left Coronary Artery LAO 45° + CAU 30° CRA 30° LM: Calcification No lessions>30% Middle LAD: 80% stenosis with calcification LCX : 90% stenosis after the OM (60%)

  5. CAG—Right Coronary Artery Transradial artery 6F arterial sheath Diagnostic catheter: Tiger(5F , Terumo Japan) JR4 (6F,Cordis US)

  6. Coronary Anomalies • Van Camp SP, et al. • Coronary anomalies cause 11.8% of deaths in US high school and college athletes. • Nontraumatic sports death in high school and college athletes. Med Sci Sports Exerc. 1995;27:641–647. • Angelini P, Villason S, et al • A study of 1950 consecutive cineangiograms, 5.6% incidence of coronary anomalies • Coronary Artery Anomalies: A • Comprehensive Approach. Philadelphia: Lippincott Williams & Wilkins;1999:27–150. Paolo Angelini, José Antonio Velasco and Scott Flamm, Coronary Anomalies: Incidence, Pathophysiology, and Clinical Relevance, Circulation 2002;105;2449-2454

  7. CAG—Right Coronary Artery Right coronary artery ostial anomalies Arising from Left anterior sinus Middle RCA 95% stenosis Inferior myocardial infarction RCA PCI !!

  8. Coronary Anomalies and PCI Coronary coxial anomalies • Bad guiding coaxial Poor Backup Support Transradial artery • Limitation of 6F guide • Limitation of radial artery Complex lesions • Chronic Total Occlusion • Excessive tortuosity • Excessive calcification

  9. How to increase the backup support Saucedo JF, et al. Facilitated advancement of the Palmaz-Schatz stent delivery with the use of an adjacent 0.0180 stiff wire. Cathet Cardiovasc Diagn 1996;39:106 –110. Tsuji T, et al., New technique for superior guiding catheter support during advancement of a balloon in coronary angioplasty: The anchor technique, Catheter Cardiovasc Interv, 2003;59:482-8 Bartorelli AL, et al. Successful stent delivery with deep seating of 6 French guiding catheters in difficult coronary anatomy. Cathet Cardiovasc Intervent 1999;48:279 –284. Takahashi S, Saito S, Tanaka S, et al., New method to increase a backup support of a 6 French guiding coronary catheter, Catheter Cardiovasc Interv, 2004;63:452-6

  10. Guiding catheter

  11. PCI Guding catheter AL1 .0 (6F Cordis US) Buddy wire technique 0.014’’ BMW (Abbott) 0.014’’Runthrough (Terumo)

  12. Assistive technology /equipment Saucedo JF, et al. Facilitated advancement of the Palmaz-Schatz stent delivery with the use of an adjacent 0.0180 stiff wire. Cathet Cardiovasc Diagn 1996;39:106 –110. Tsuji T, et al., New technique for superior guiding catheter support during advancement of a balloon in coronary angioplasty: The anchor technique, Catheter Cardiovasc Interv, 2003;59:482-8 Takahashi S, Saito S, Tanaka S, et al., New method to increase a backup support of a 6 French guiding coronary catheter, Catheter Cardiovasc Interv, 2004;63:452-6

  13. 5 in 6F Childing catheter • Normal guiding catheters like JR、AL， • 100 cm in length • inner lumen of • the outer 6 Fr catheter needs to be more than 0.071 in diameter 5 Fr guiding catheter (Heartrail,Terumo):120 cm in length, A very soft 13 cm end portion. Inner lumen is 0.059 in diameter;

  14. 5 in 6F Childing catheter • 6 Fr guiding catheter alone :63.1±2.1 gf • Only inserting the 5 Fr guiding catheter backup support : 72.0 ± 3.7 gf • 5 mm into the artery, its backup support was 106.5 ± 3.9 gf, stronger than 7F (96.7 ± 2.6 gf) Conlusion: The five-in-six system can generate a stronger backup support by a longer insertion of the 5 Fr catheter into the artery model. Takahashi S, Saito S, Tanaka S, et al., New method to increase a backup support of a 6 French guiding coronary catheter, Catheter Cardiovasc Interv, 2004;63:452-6

  15. PCI Childing catheter 5F Heartrail (Terumo) Ryujin plus 2.0*20mm (Terumo) Pre-dilation:6~12atm*5s

  16. PCI Firebird2 2.5*23mm 12atm*10s Firebird2 3.0*23mm 12atm*10s

  17. PCI

  18. Experience in our centre 2009.09~2010.2 Department of Cardiology, Zhongshan Hospital, Fudan University, 15 cases of PCI adopted the“5 in 6F child guiding catheter technique” 12 of them successed; 3 cases failed

  19. Thank you for your attention.

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