Left coronary engagement (radial focus): detailed steps, diagrams, tips, and case videos-Elias Hanna
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- Опубліковано 10 сер 2022
- Note that the torque done while advancing the JL catheter toward the aortic valve (step 2 at 14:14, and at 47:04) is only a slight clockwise torque (usually), less than 30 degrees usually. do not overclock during that maneuver.
0:00 Diagrams of catheter shapes and elongations from radial vs femoral access, left and right coronary. Which catheters for radial vs femoral? Catheter pointing up, next step? pointing down, next step? Brief description of Amplatz (1:06:56)
09:35 Detailed diagrams and descriptions of steps 0 to 3A+3B in LCA engagement. + Recorded case illustrations (simple and complex). Jump then: Engage from above vs from below
30:09 Guiding catheter specifics with diagrams and cases. What size guiding catheter in relation to JL size, from radial vs femoral?
43:35 How to go from descending to ascending aorta
47:04 Cases of difficult aortic angulations. Role of deep inspiration (diagram 50:20)
55:05: Elongated catheter and fallen catheter. Next steps? (Diagram 56:30)
57:44 How to go from LCx to LAD, and vice versa. 5 techniques with diagrams and cases.
Wonderful talk... Cath is made easy.... Priceless tips.....heartfelt thanks❤❤
You are one of best teachers. Thanks heaps for sharing.
Thank you so much for these invaluable information Dr. Hanna!
Fantastic lecture, Dr. Hanna.
Thank you for all of the time you put into making such excellent slides and screen captures.
I ve searched for this kind of video for so long !
Thank you so much
Thank you for the great lecture.... Really grateful to you sir❤❤
Really fantastic
Thank you so much! 👍🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥
THANK YOU
Thank you very much dear dr Hanna.
Excellent. As usual.
Could you please we have a video of FFR, iFR, CFR?
Great suggestion
Dear Sir, Excellent talk. How do you deair catheter once you have wire in catheter to enngage the coronary..
Awesome video, still i wish to dectate about how to use size and stent length in coronary stenting
thanx u doctor
Thank you dr Hanna , i have 2 questions please, you said that if we want to cannulate the LM with the JL 3.5 from above, we pull the catheter with slight clockwise tork, but in practice our masters teach us frequently to tork counterclockwise in this situation to bring the catheter to an anterior position, where theoretically the left ostium should be
The second question is , when we jump into the left cusp but we are not in the ositum, what maneuvers should we use to find the ostium , or should just miss around to find it ( dissection risk ) ? thank you again for this amazing topic
-When you are going down through the ascending aorta (step 1), CLOCK torque slightly (10-20 degrees) with deep breath
-To cannulate the LCA from above (step 3A), EITHER CLOCK or COUNTERclock may be used. I generally start with mild and clock, and I watch carefully the behavior of the catheter; if it is turning away from the LCA and about to fly out to the convexity of the aorta, I immediately reverse to counterclock. This is the most important skill to acquire.
For EBU/CLS type of guide catheters, COUNTERclok is often more successful
-If engaging from above does not work (3A), or if the aorta is sharply angled, try to engage by looping the catheter from below (3B), and if it does not get in, you pull it back, give it a slight torque, then loop it again in another plane. For EBU/CLS guide catheters, counterclock is often more successful for this part,
Additional notes:
-Counterclock can point JL anteriorly, but not always, as I explained in other videos. If the catheter secondary bend is sitting on the aorta, counterclock points you anteriorly, but in the absence of this hinge, clock points you anteriorly.
Also, clock points the JL/Tiger catheter up, which often proves helpful as in the example 25:26
-Yes, there is a slight risk of dissection with those attempts, but it has never happened with me during those particular maneuvers. The risk is higher if you allow your catheter to dive too deeply in the coronary (eg pulling AL or pulling EBU guide to deeply dive it in the coronary)
New cardiology radiographer here, silly question what do you mean by engaging?
Dear Dr Hanna
Thank you for your lecture
Many times when i try to push the catheter to engage from down it is stuck in the aortic valve.
May you please provide tips and tricks on how to do so and how hard can we push in the ascending aorta?
Thank you
Great point. If that happens, consider 2 things: (1) try to pull the catheter until it is free, give it a slight torque to get it into a different plane, then attempt pushing it again; you may try that a couple of times; (2) if the latter does not work, the likely issue is that your catheter is too large and bulky for that aorta; thus, I would consider downsizing (for example, if you are using CLS 4, go down to 3.5, or 3.5 to 3). I had this issue twice this week with CLS 3.5 in patients with narrow aorta, I had to downsize to CLS 3
@@eliashanna8248 thank you Doctor
sir....kindly post a video on torque technique
Excellent elaboration as always 👍 can you explain how to maneuver AL for both left & Rt coronary engagement??
Thank you. I actually just uploaded a talk about RCA and about AL maneuvering for both RCA/LCA/grafts
@@eliashanna8248 Superb.. thank you so much 👍
👍
worth than my 4 years cardiotech student.
👍👍
respected sir. i had a doubt. while using EBU from right radial artery and engaging LMCA from downwards (U technique); u described it to give torque and push. so the torque should be clock or anticlock???
thank you ..
Good question. As I indicated between minutes ~16:30 and 19, we generally clock torque as we are getting down through the aorta to the right cusp. To engage using the U technique (from below 3B), or to engage using the straight technique from above 3A, either clock or counterclock or no torque at all may work, there is no definite rule. It is more frequently counterclock that works for the EBU U technique, but it really depends on how much clock you had done already to reach the left cusp (as you were going down the aorta then jumping to the left cusp). Some tips:
-For the straight technique 3 A: as you are pulling with a slight torque, it is most important to QUCIKLY react to the catheter behavior. IF the catheter is about to fly out of the left cusp, you immediately reverse your torque; hence start with a slight torque and depending on the behavor, keep torquing in the same direction or reverse.
-For the U technique 3 B: make sure the catheter tip is free over the left cusp as you are pushing it, not feeling stuck (you may need to pull and torque to free it). Then you may start with a slight counterclock during your push; if it does not work, pull back to straighten the catheter and free it and push again with a clock maneuver.