title: Brachial approach to NOGA-guided procedures: electromechanical mapping and transendocardial stem-cell injections.
abstract: Several methods are available for delivering stem cells to the heart. Recent studies have highlighted the advantages of injecting the cells directly into the myocardium in order to increase myocardial retention of cells. A particular focus has been on percutaneous transendocardial injection, facilitated by electromechanical mapping.The NOGA XP Cardiac Navigation System has a multicomponent catheter that is designed to guide and deliver transendocardial injections via a transfemoral approach, without a guidewire. However, this method may not be feasible in some patients who have peripheral vascular disease. Herein, we describe the case of a 68-year-old man whose tortuous, sharply angled iliac arteries precluded a femoral approach to transendocardial injection. To overcome the anatomic and mechanical challenges, we used a brachial approach. We believe that this is the 1st report of using the brachial route for transendocardial injection, and that it can be a viable alternative to the transfemoral approach in selected patients.
authors.affiliation: Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia.
authors.forename: Marko
authors.initials: M
authors.lastname: Banovic
authors.forename: Miodrag C
authors.initials: MC
authors.lastname: Ostojic
authors.forename: Jozef
authors.initials: J
authors.lastname: Bartunek
authors.forename: Milan
authors.initials: M
authors.lastname: Nedeljkovic
authors.forename: Branko
authors.initials: B
authors.lastname: Beleslin
authors.forename: Andre
authors.initials: A
authors.lastname: Terzic
mesh_terms: D000368:Aged; D001916:Brachial Artery / Q000000981:diagnostic imaging; D006328:Cardiac Catheterization / Q000295:instrumentation; D057785:Catheters; D022062:Electrophysiologic Techniques, Cardiac; D004699:Endocardium; D004867:Equipment Design; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging; D007267:Injections; D008297:Male; D020127:Recovery of Function; D033581:Stem Cell Transplantation / Q000295:instrumentation / Q000379:methods*; D013813:Therapy, Computer-Assisted / Q000295:instrumentation; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome