Need assistance please with this procedure.
I think I am making more out of it than I should be...
Ultimately, a 5-French sheath was placed
into the right radial artery without difficulty. Attempts to advance a
5-French catheter into the radial artery were unsuccessful and I switched over
to a 4-French JR4 catheter. Utilizing a Wholey wire, I was able to advance
the wire to the innominate artery and it would not advance any further. At
this time, I advanced a 4-French JR4 to the proximal portion of the right
subclavian artery and an angiogram was performed, which revealed severe
stenosis in the proximal portion of the right subclavian. I was now able to
manipulate the Wholey wire into the ascending aorta with little difficulty and
advanced the JR4 into the ascending aorta and coronary angiography of the
right coronary artery was performed. In attempting to pull back the 4-French
sheath, much resistance was found related to coronary vasospasm. At this
time, intra-arterial verapamil was given, which did relieve some spasm and the
sheath was removed. When advancing the wire, the Wholey kept going into the
side branches and I was not able to get the wire into the main arterial
channel. After multiple attempts, decision was made to move over to the left
side.
The left brachial artery was now prepped and draped in the usual manner. With
little difficulty, I was able to cannulate the left brachial artery utilizing
the micropuncture technique and a 4-French sheath was placed into the brachial
artery. I advanced the Wholey wire and once again at the proximal portion of
the artery resistance was made. I advanced the 4-French JR4 to that tegion
and angiogram was performed which revealed total occlusion at the ostium of
the left subclavian artery.
I think I am making more out of it than I should be...
Ultimately, a 5-French sheath was placed
into the right radial artery without difficulty. Attempts to advance a
5-French catheter into the radial artery were unsuccessful and I switched over
to a 4-French JR4 catheter. Utilizing a Wholey wire, I was able to advance
the wire to the innominate artery and it would not advance any further. At
this time, I advanced a 4-French JR4 to the proximal portion of the right
subclavian artery and an angiogram was performed, which revealed severe
stenosis in the proximal portion of the right subclavian. I was now able to
manipulate the Wholey wire into the ascending aorta with little difficulty and
advanced the JR4 into the ascending aorta and coronary angiography of the
right coronary artery was performed. In attempting to pull back the 4-French
sheath, much resistance was found related to coronary vasospasm. At this
time, intra-arterial verapamil was given, which did relieve some spasm and the
sheath was removed. When advancing the wire, the Wholey kept going into the
side branches and I was not able to get the wire into the main arterial
channel. After multiple attempts, decision was made to move over to the left
side.
The left brachial artery was now prepped and draped in the usual manner. With
little difficulty, I was able to cannulate the left brachial artery utilizing
the micropuncture technique and a 4-French sheath was placed into the brachial
artery. I advanced the Wholey wire and once again at the proximal portion of
the artery resistance was made. I advanced the 4-French JR4 to that tegion
and angiogram was performed which revealed total occlusion at the ostium of
the left subclavian artery.