Successful transradial intervention via a radial recurrent artery branch from the radioulnar alpha loop using a sheathless guiding catheter

Figures

• 

  Fig. 1.. A radial recurrent artery originating from the radioulnar alpha loop. Left radial angiography (A) shows the radioulnar alpha loop and a well-developed recurrent radial artery (arrows) running parallel to the brachial artery (B, C).

• 

  Fig. 2.. Coronary angiography and intravascular ultrasound. Left coronary angiography (A) reveals diffuse significant stenosis in the proximal to mid LAD (arrow). IVUS examination (left low in A) showed severe plaque accumulation with a lesion minimum lumen area of 1.6 mm3, an external elastic membrane area of 11.9 mm3, and a plaque burden of 86.6%. Right coronary angiography (B) shows tubular 60-70% stenosis in the mid to distal right coronary artery (arrow). IVUS examination (right low in B) showed diffuse fibrous plaque accumulation with calcification. The lesion minimum lumen area, external elastic membrane area, and plaque burden measured 2.2 mm3, 15.3 mm3 and 85.6%, respectively. Post-stent angiography of LAD (C) and IVUS showed good appearance, and well apposed and fully expanded stent (left low in C). Post-stent angiography of right coronary artery and IVUS showed good appearance, and well apposed and fully expanded stent (D). LAD, left anterior descending artery; IVUS, intravascular ultrasound.

• 

  Fig. 3.. The sheathless guiding catheter system and its lumen size. The sheathless GC system is composed of a hydrophilic guiding catheter and a long central dilator. The 6.5 Fr sheathless GC has an outer diameter (2.16 mm) smaller than that of a 5 Fr introducer sheath (2.29 mm), with an inner diameter (1.78 mm) similar to that of a 6 Fr GC (1.78-1.8 mm). GC, guiding catheter; OD, outer diameter; ID, inner diameter.