RM & CR catheter (4 F, JSM Korea). Designed for 4 F transradial bilateral angiography with single catheter. Those catheters have three side holes to prevent pulling back during the contrast injection and to enhance more contrast delivery for better image quality through the slender 4 F catheter lumen
RM Guiding catheter (5 F, 6 F) for transradial intervention
Many guiding catheters can be used for transradial bilateral coronary angioplasty. The choices are listed in Table 7.2.
Transradial guiding catheters for bilateral engagement
Radial brachial (RB)
Brachial left (Tilon)
Radial Bi-lateral (RBL)
Ikari Left (IL)
Multi-Aortic curves (MAC)
In some of above catheters, such as kimny, Radial brachial and Radial Back-up, the shapes of these catheters are similar except the slight differences in the angle of second curve or distance between the first to the second curve. Kimny catheter (Boston Scientific) is the first multipurpose catheter designed for right radial approach TRI. The specific design of guiding catheters curves, such as Kimny, Ikari Left, can give optimum support besides the convenient engagement. Amplatz left guiding catheter is considered to provide the strongest support among them. Although Judkins left can be used in TRI, its curve is originally designed for TFI, which make the manipulation not as easy as it was in TFI, especially during engagement of right coronary artery, and it is not as feasible as IL or Kimny during TRI procedure. However after its engagement, Judkins left can give excellent support. Just like Judkins catheter was named by Judkins, RM guiding catheter (5 F, 6 F, JSM Korea) was invented and entitled by Rha SW.
Overall, the use of single guiding catheter for transradial bilateral coronary intervention is safe, feasible and highly successful in most patients. The previous study reported 96.6 % of success rate as efficient at right and left of coronary arteries by single IL 3.5 transradial guiding, and 96.0 % by Kimny guiding catheter [2, 22]. In all cases, manipulating the catheter from one side to the other (especial from left to the right coronary artery) should be performed with care in order to prevent tip dissections or inadvertent and uncontrolled deep intubation . Taking IL as an example, the overall incidence of right coronary artery (RCA) dissection is about 0.48 % according to previously reported study . Compared to Judkins Right catheter, IL can provide stronger support, and also might engage into RCA deeply and forcefully (Fig. 7.3), however on the other side, it also may cause dissection, especially when the ostia are atherosclerotic.
The following figures illustrate the procedure of transradial bilateral coronary intervention with a single 6 F Ikari Left guiding catheter (Terumo). (a) angiogram of left coronary artery. (b) angiogram of right coronary artery. (c) stenting of circumflex lesion. (d) final angiogram of left coronary artery. (e) stenting of proximal right coronary lesion. (f) final angiogram of right coronary artery (Single transradial catheter performance from Korea University Guro Hospital)
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