Javier Goicolea

1
Minimally invasive strategy 5F TRI

• Javier Goicolea
• Interventional Cardiology Unit
• Clinica Puerta de Hierro
• Madrid Spain

Partially presented during Euro-PCR 2005 Case
review session Minimally invasive strategy the
quiet revolution
Case
2
Case Presentation

• 70 y old female. Diabetic requiring Insulin.
• ACS in 2003 managed medically.
• Admitted because of unstable angina (chest pain
  at rest) with transient ST depression in inferior
  leads.

TRI
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Coronary Angiogram

• Right Radial approach
• 5F hydrophilic introducer (Terumo).
• Spasmolytic cocktail (Heparin 5000Verapamil3.5mg)
  
• Diagnostic 5F JL 3.5 and JR4.

Materials
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LCA
5F JL 3.5
5
RCA
5F JR 4
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Balloon Dilation

• Guiding JFR, 5F, LBT.
• Guidewire Choice (BSC)
• Balloon Sprinter 2.0x12
• Great difficulty in navigation through the
  calcified mid-RCA!

Low back-up
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Deep Seating
Featuring Back-up issue
Maximizing 5 F by TRA
How to overcome 5F limitations
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Final Result

• Stent Taxus 2.5x12mm (without difficulty).
• From distal RCA
• towards proximal PD
• 12 Bar
• Excellent result.

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5F Usage
Clinica Puerta de Hierro Madrid, Spain
Daily practice
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5F Usage
Curves
Clinica Puerta de Hierro Madrid, Spain
Daily practice
11
5F Usage
Technical aspects
Tips and Tricks

• Advance over guidewire or
• balloon-guidewire unit.
• Anchor with balloon if difficulty in advancing.
• Soft tip guiding catheters.
• Open non angulated curves.
• Torqueadvancement.

Maximizing 5 F by TRA
12
Balloon Anchoring
Technical Tip trick
Focus