5F in 6F (7F) technique in DES era

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5F in 6F (7F) technique in DES era
(Parent-child catheter technique)
Kyoto 2nd Red Cross Hospital, Japan
Naoto Inoue M.D. FJCC FSCAI
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Key Points in DES era

• Simple procedure is recommended
• Debulking device plays a small role except
  calcified or bifurcated lesion
• Safe DES implantation is important

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For the DES delivery

• Longer is better ? 23, 28, 33mm stents are
• frequently used

• The deliverability of long stent is not good
  especially in the calcified or tortuous lesion

• We need the technique for the safe DES delivery

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1 Catheter selection
RCA Amplatz, Hockey, Champ LCA XB, EBU, Amplatz
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6F EBU catheter

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2 Pre dilatation ,pre debulking
Enough predilatation (high pressure, large
balloon) Rotablator (calcified lesion)
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Strong guide cathe, enough pre dilatation,
debulking failed
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Anchor technique
Side branch anchor
Peripheral anchor
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Cross of balloon catheter
LCX guide wire 2.5mm balloon dilatation
LAD CTO
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Cross of balloon catheter
1.5mm balloon pass the lesion
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Anchor technique for CTO
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5F in 6F(7F) technique
6F mother cath. (Heartrail Terumo Co.)
6Fgt0.070 inch (Launcher, Heartrail Radiguide)
5F child cath. (20cm longer than mother
cath. Terumo Co.)
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5F in 6F technique
Hemostatic valve
Hemostatic valve
Yconnector
Heartrail 5Fr straight
Y connector
Heartrail 5Fr straight
Heartrail 6Fr
Heartrail 6Fr
Hemostatic valve not good
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5F in 6F technique
dissection
G.C. 6F Heartrail JL 3.5 G.W. BMW wire
S670 could not cross the lesion
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5F in 6F technique
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5F in 6F technique
During stenting
Post stenting
Child catheter
Child catheter
Child catheter
Child catheter
Child catheter
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Artery model
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RCA tortuous calcified lesion HD patient
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Two step 5 in 6
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Method of 5F in 6F
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Alternative 5F in 6F (7F) technique
Child catheter goes across the stenotic lesion
No risk of stent dislocation
No risk of DES polymer peeling off
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CABG (LITA?LAD, SVG?PL) Hemodialysis
50 y.o. male
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Child catheter
????
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2.5x18mm Cypher
3.0x13mm Cypher
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??
???
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Complication

• Vessel injury
• Air embolism

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Vessel injury
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Air embolism

• We have one air embolism
• Air embolism will occur when child catheter is
  wedged
• or angiography after stent deployment

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Safety use for 5 in 6F technique

• Gently advancement of child catheter into the
  coronary
• artery
• Careful monitoring distal coronary pressure
• Check the blood back flow from Y-connector just
  after
• stent deployment

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Thank you !!