A Q&A for Cath Labs with Physicians Performing Radial Access

Does your physician do any peripherals through the radial artery? Yes, we do some peripherals on selected patients through the left radial, because it is a shorter distance from the left as compared to the right. We performed a case from the left radial using the CSI Diamondback 360˚ PAD system (Cardiovascular Systems Inc., St. Paul, Minn.), an orbital atherectomy device. Heparin was administered. We advanced a Viper wire (Cardiovascular Systems) distally into the right superficial femoral artery (SFA) and then performed orbital atherectomy of the ostium of the iliac artery with a 2 mm crown. There was approximately 2 minutes of run time with the orbital atherectomy device. Following orbital atherectomy, we predilated with a 6.0 x 20 mm balloon. There was a small dissection noted and therefore we placed a 8.0 x 29 mm Genesis stent (Cordis Vascular, Warren, New Jersey) to the ostium of the iliac artery. Final angiography was then performed with a pigtail in the distal aorta and a runoff of 10 for 30 at 600 psi, revealing that there was 0% residual stenosis. The ostium of the iliac was patent, as was the ostium of the left iliac, with no plaque shift. The sheath was withdrawn and a TR Band (Terumo Medical Corp., Somerset, New Jersey) was placed over the radial artery. Using the Diamondback 2.0 crown, we were able to change the compliance of the vessels to accommodate the 8.0 by 29.0 mm Genesis stent. Here are some of the reasons why we choose to use the Diamondback 360:

• Sands noncompliant, calcified and fibrotic tissue. • Allows the more elastic media layer to flex away from crown. • Reduces or eliminates barotrauma, unlike balloon angioplasty alone. • Changes compliance if adjunctive percutaneous transluminal angioplasty is needed: fewer atms needed means less barotrauma and fewer dissections.

Note: The physician performing this procedure was Dr. Zaheed Tai. Email your question to: orlando.marrero@winterhavenhospital.org

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