5F TRI IN LMCA

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5F TRI IN LMCA
Karam Souibrion 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

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5F TRI IN LMCA

• What to do ?
• CABG?
• PCI?
• - switch to femoral?
• - switch to 6F? 7F?
• - direct stenting?
• - drug eluting stent?

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5F TRI IN LMCA

• Maintained guiding 5F JL4
• Direct LMCA stenting (Express 5mmx16mm)
• Difficulties to progress the following stents in
  LAD
• - Stop procedure?
• -Switch 6F?
• - Any other trick?

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5F TRI IN LMCA
Buddy wire technique for stent placement

• Buddy Wire (parallel wire)
• (Choice guidewires 0.014 )
• Successfull stent placement and deployement in
  the 2 LAD stenosis
• (Motion MV3.5x13mm and 3x13mm)

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5F TRI IN LMCA

• PCI using 5F Radial access can routinely be
  performed
• 5mm stents in selected cases
• Can be considered
• Deep catheter intubation is frequently required
  for direct stenting
• Buddy wire technique avoids switching to larger
  catheters