He was brought to the catheter lab for coronary restudy. His background included a previous stroke, hypertension, chronic kidney disease stage 3, hyperlipidaemia and being an ex-smoker. Case 1Ī 64-year-old man presented to the cardiology clinic six years following coronary artery bypass grafting (CABG, left internal mammary artery to left anterior descending left radial artery to obtuse marginal saphenous vein graft to right coronary artery ) with increasing angina and shortness of breath refractory to medical therapy. This technique demonstrates that cardiologists do not necessarily need to resort to routine femoral access when the ipsilateral radial artery is not available.
6 fr guideliner series#
We present a case series illustrating a simple technique for selective angiography of an IMA graft from the contralateral radial artery. Given the superior outcomes of arterial over vein graft revascularisation, 9,10 we can only assume that the number of these patients presenting for angiography will increase in the future. Although the ipsilateral radial artery provides a direct route to an IMA graft, the advantage of this route is lost when bilateral IMA grafts need to be visualised, or when the required radial artery has been used for grafting. One such traditional bastion of the femoral approach is internal mammary artery (IMA) graft angiography. Nonetheless, femoral access undoubtedly continues to remain relevant in situations such as large bore and complex intervention, the need for mechanical support devices, and structural intervention. 6,7 Even putting the preferences of transradial enthusiasts aside, it also seems that patients who have had experience of both access routes prefer use of the radial artery. While many in the interventional cardiology community consider the debate of routine radial versus femoral access for coronary angiography to be all but over, 1-5 there, nonetheless, continues to be a wide variation in the uptake of transradial access worldwide. We describe a case series showing a simple technique for selective cannulation of the LIMA from the right radial artery using a single catheter that provides sufficient backup for percutaneous coronary intervention (PCI). While the right radial artery is ideally suited in these situations for cannulation of the right IMA, accessing the left IMA (LIMA) by this route is often perceived as challenging and for ‘radial evangelists’ only. This is particularly the case for bilateral pedicled IMAs, or when the left radial artery has been grafted. Angiography of internal mammary artery (IMA) grafts continues to be a common indication for upfront femoral access.
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