Background: Transradial approach (TRA) is a preferred method for coronary angiography and interventions due to reduced vascular and cardiac complications and increased patient's comfort and satisfaction. TRA in patients with previous CABG is technically challenging. In cases when both LIMA and RIMA in situ or LIMA and left radial artery (LRA) are used as grafts the left radial approach can not be used and TRA is frequently considered as contraindicated. We describe our initial experience in selective LIMA catheterization from right TRA in unselected series of patients using a single dedicated catheter.
Methods: We studied ten consecutive patients with a history of CABG referred for cardiac catheterization. Eight patients had both LIMA and RIMA in situ as grafts, one patient had LIMA and LRA and in one patient the use of left TRA was difficult due to morbid obesity. We used a dedicated Bartorelli-Cozzi catheter to enter left subclavian artery from right TRA and to selectively engage LIMA.
Results: An adequate radial access was obtained in all patients. In seven patients a successful selective LIMA angiography was performed, in two patients the angiography was non-selective but with good image quality and in one patient the right TRA failed because of severely calcified and tortuous left subclavian artery and converted to a left radial approach. In five patients the angiography was followed by angioplasty. There were no procedure-related complications.
Conclusions: The angiography of LIMA grafts from right TRA is feasible and safe. In patients with previous CABG, the presence of LIMA graft not precludes the successful diagnostic and interventional procedures from the right TRA.
