Transradial Approach for Calcified and Tortuous Lesions

Abstract

The size of the guiding catheter (GC) commonly used in transradial coronary intervention (TRI) is 6 Fr or smaller. Since this size inevitably provides less backup support than a 7Fr or 8 Fr GC, even in institutions that have taken up TRI, operators may often select transfemoral coronary intervention (TFI) over TRI for procedures requiring sufficient backup support because it facilitates the use of large diameter GCs.

Calcified and tortuous lesions—the topic of this manuscript—are representative of lesions that often require strong GC backup support. In order to treat such lesions through TRI, operators would need to master several techniques that are key to achieving backup support of 6Fr.GCs equal to or better than that of 7 Fr GCs.

In the following sections, proper understanding of GC selection and, moreover, the techniques that could be powerful tools in achieving GC backup support in the treatment of severely calcified lesions and tortuous lesions by TRI, will be briefly explained while citing cases. Unless otherwise noted, all of the case studies presented here are TRI cases that were conducted with a 6 Fr GC.