title: Downsizing from 6-French to 5-French guiding catheter after transradial coronary rotational atherectomy: a way to cross resistant calcified lesions.
abstract: Some severe calcified coronary lesions may resist the advancement of the stent despite rotational atherectomy and balloon predilation, when used via the transradial approach due to a lack of support of the guiding catheter and may require switching to the femoral approach. The latter is known to have better support but with the increased risk of vascular access site complications. Deep engagement of the guiding catheter with preferring 5-French to 6-French to avoid coronary dissection provides an active support and may be a solution in such situations. We report two cases of patients with calcified coronary lesions, where rotational atherectomy and balloon predilation were not sufficient for the stent to cross the lesion and switching to 5-French guiding catheter allowing a safe deep engagement which was the solution using the transradial access.
authors.affiliation: CHU de Caen, Department of Cardiology, Caen, France.
authors.forename: Ziad
authors.initials: Z
authors.lastname: Dahdouh
authors.forename: Vincent
authors.initials: V
authors.lastname: Roule
authors.forename: Gilles
authors.initials: G
authors.lastname: Grollier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation; D017225:Atherectomy, Coronary / Q000295:instrumentation*; D057785:Catheters; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D017534:Radial Artery; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000628:therapy*