Post on 31-Dec-2015
description
5F TRI IN LMCA Karam Souibri
on behalf of the Interventional cardiology departmentUniversity Hospital of Caen, France
• INTRODUCTION
• 5F TRI is safe and feasible for PCI and direct stenting.• Need for large diameter stents, low back-up… can be considered
as severe limitations• In routine practice some tip and tricks can help to overcome these
limitations
Case report• Non ST ACS 67 year-old dyslipidemic patient• Treated with GpIIb/IIIa inhibitors• 5F JL4 guiding catheter (Launcher form Medtronic)• Revealing ulcerous stenosis in a 5mm caliber LMCA and 2 other
significant narrowings in proximal and mid LAD
• What to do ?• CABG?• PCI? - switch to femoral? - switch to 6F? 7F? - direct stenting? - drug eluting stent?
• Maintained guiding 5F JL4
• Direct LMCA stenting (Express 5mmx16mm)
• Difficulties to progress the following stents in LAD
- Stop procedure? -Switch 6F? - Any other trick?
• Buddy Wire (parallel wire)
(Choice guidewires 0.014 ’’)• Successfull stent
placement and deployement in the 2 LAD stenosis
(Motion MV3.5x13mm and 3x13mm)
Buddy wire technique for stent placement
• PCI using 5F Radial access can routinely be performed
• 5mm stents in selected casesCan be considered
• Deep catheter intubation is frequently required for direct stenting
• Buddy wire technique avoids switching to larger catheters