Feasibility of Multi-Vessel PCI to Both Left and Right Coronary Arteries by Trans-Radial Approach Using JL as a Multipurpose Guiding Catheter

Background:
Guide catheter selection during transradial intervention is important for procedural success. Although both LMCA and RCA can be engaged by a single catheter such as Tiger for diagnostic purposes, PCI is usually performed by selective engagement of coronaries via dedicated catheter. Use of separate guides for multi-vessel PCI requires catheter change, leading to radial artery spasm, longer procedure time and increased cost, particularly when borne by financially-challenged patients in low income countries. Judkins Left (JL) guide catheter can be easily manipulated and used as a multi-purpose guide to engage both the LMCA and RCA for PCI by trans-radial approach (TRA).

Methods:
Consecutive multi-vessel PCI requiring both LMCA and RCA cannulation were included. Demographic data, type/size of left sided (JL/ XB) guide, number of vessels stented, procedural time, switch over to Judkins Right guide and complications were statistically analysed. P<0.05 was considered statistically significant.

Results:
A total of 451 patients underwent multi-vessel PCI in both RCA plus either LAD or LCx by single left sided guide catheter. 363 (80.5%) underwent double-vessel PCI. 88 (19.5%) had triple vessel PCI. 2.7% had chronic total occlusion (CTO) and 1.8% had in-stent re-stenosis (ISR) of RCA. JL 3.5 5 French guide was the most frequently used catheter for both artery canulation in PCI (87.6% of cases). In 6.2% , JL 3.5 6 French catheter was used. JL 3.0 6 F catheters was used in 5.3% of cases. XB guide was used in 4 (0.9%) cases. In double vessel PCI group, 187 (41.5%) underwent PCI to LAD and RCA; 180 (39.9%) underwent PCI to LCx and RCA. 18.6% underwent PCI to LAD, LCx and RCA with single JL guide catheter. Patients in whom single catheter was used had significantly lesser procedure time, radiation time and dye load (P<0.05), in addition to reduced cost. Switch-over to JR guide was 0.3%, mostly in case of CTO of RCA.

Conclusions:
The use of JL guide as a multi-purpose guiding catheter in multi-vessel PCI for both RCA and LMCA canulation in TRA is a feasible alternative to the use of separate guide catheters, resulting in lesser procedure and radiation time,and reduced cost.