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