Cath Lab Digest

A 60-year-old gentleman presented with angina and a mild reversible defect in the lateral and infralateral segment. The patient underwent coronary bypass 25 years ago and had a previous patent internal mammary vessel with 100% occlusion of the right coronary with a patent graft to the ramus and internal mammary to the lower anterior descending artery (LAD). He presented with mild angina. The angiogram shows the internal mammary to be patent. The ramus, which was previously patent in a study the year before, had a focal stenosis. LV function was maintained with an EF of 60%.

We became a radial first lab in April 2010, and do virtually all of our coronary cases via the right or left radial artery. It has been reported that as many as 40% of cases with saphenous vein graft stenosis cannot have embolic protection devices due to inability to place. About 10 years ago, we developed a technique where we performed suction thrombectomy during deployment of the stent to minimize embolic phenomena (Figures 1, 2, 3).

This case shows the successful use of the radial approach in PCI. This approach is used in more and more centers in the U.S. as well as the use of the continuous suction Suck-U-Surge technique to reduce the likelihood of embolic phenomena (Figures 4, 5). This case illustrates new techniques as well as the radial approach. We will be discussing the radial approach at our upcoming meeting in Las Vegas.

We are excited about our second meeting Cardiovascular Tips for the Practitioner: Optimizing Management Techniques and Treatment. For the first time, we have a cosponsored radial course with SCAI with some of the national leaders including Mehrdad Sairain, Tift Mann, and Ian Gilcrest. We look forward to seeing you at our meeting at the Encore Hotel in Las Vegas on September 9–11, 2011.

Figure 1 – Patent LIMA graft

Figure 2 – Left coronary angiogram shows the left system to be functionally occluded

 Figure 3 – The RCA is 100% occluded

Figure 4 – The left ramus graft angiogram reveals a focal stenosis

 Figure 5 – Placement of the DES in the SVG

Figure 6 – Deployment of stent using “Suck-U-Surge” technique

Figure 7 – Angiogram post stenting