Case 18: Manual of non-CTO interventions: Radial PCI - when to switch?


A patient was referred for PCI of an ostial lesion of the first obtuse marginal branch. Radial access was used with a 6 Fr Ikari left 3.5 guide catheter and a Guideliner. Provisional stenting was planned. Attempts to deliver a stent to the first obtuse marginal branch failed and caused acute vessel closure. Femoral access was obtained while maintaining wire position into the OM1. Both OM1 and the distal circumflex were rewired and stents delivered restoring flow to the OM1 and distal circumflex. In case of a complication, if guide catheter support using radial access is poor, prompt conversion to femoral access can often provide a solution.