Bilateral Radial Access for CTO Recanalisation

Background: TRA is preferred vascular access for the most interventionalists worldwide. Distal radial access is promising technique for performing PCI, using left radial artery

Methods: 62 y.o. female patient with effort angina was admitted in our hospital for CTO recanalization of proximal LAD, after a failed attempt 2 years ago, and mid RCA stented 3 years ago. Angiogram shows 10mm ocluded segment of proximal LAD, and no significant lesions of RCA and Cx. We used antegrade CTO technique via right RA and simultaneous contralateral injection via left distal RA. Using 6F GC, we advanced Fielder XT guide wire and Finecross microcatheter for the lesion crossing. After the failed first attempt we exchanged Fielder XT with Pilot 200 and successfully crossed the occluded segment. CTO wire was exchanged with normal workhorse wire and lesion preparation with 1.5 mm, 2.0 mm and 2.5 mm SC baloons was done. SB was jailed and 3.0x48 mm DES deployed. At the end POT with 3.5x15 mm NC balloon was done.

Results: Using bilateral radial access and antegrade CTO technique we restored normal coronary flow with optimal stent deployment and no SB compromising. Total procedural time was 47 min, radiation exposure time was 29 min, and we used 130 ml of contrast dye. Compressive bandages were used for the hemostasis of both radial arteries and the patient was discharged at the same day.

Conclusion:Bilateral radial access is feasible and safe procedure that can be used for CTO recanalization, providing less puncture site complications and shorter hospitalization