title: The utility of extension catheters in transradial percutaneous coronary intervention.
abstract: OBJECTIVE
  To evaluate the use of extension catheters in transradial intervention of complex coronary lesions.
  
  
  BACKGROUND
  Complex percutaneous coronary intervention (PCI) via transradial approach remains a challenge for many interventionalists, primarily due to the difficulty in obtaining adequate guide catheter support.
  
  
  METHODS
  A retrospective case series identified 54 patients who presented for PCI of complex coronary lesions. A lesion was defined as complex if it contained severe calcification, proximal tortuosity, chronic total occlusion, or was located distal to a previously implanted stent. After identifying the complex lesions, a conversion to femoral approach was considered, but an attempt via the transradial approach with the use of an extension catheter was chosen as the initial strategy. Specific cases highlighting this approach are illustrated in detail.
  
  
  RESULTS
  The average age of the patients was 72 years old, with male predominance (55%). The success rate of completing the transradial intervention with the help of an extension catheter was 96%. Stent delivery failed due to severe tortuosity and calcification in only 2 cases. The coronary artery involved was either the left anterior descending (n = 25), the left circumflex (n = 10), the right coronary artery (n = 14), or a saphenous vein graft (n = 5). There were no coronary dissections evident from use of the extension catheter.
  
  
  CONCLUSIONS
  In the treatment of complex coronary lesions via the transradial approach, the use of an extension catheter may assist in improving successful intervention and decrease the frequency of crossover to a femoral approach.
authors.affiliation: Beth Israel Medical Center, 139 Centre St, Rm 307, New York, NY 10013 USA. Kwancardio@aol.com.
authors.forename: Tak W
authors.initials: TW
authors.lastname: Kwan
authors.forename: Ravi
authors.initials: R
authors.lastname: Diwan
authors.forename: Justin A
authors.initials: JA
authors.lastname: Ratcliffe
authors.forename: David
authors.initials: D
authors.lastname: James
authors.forename: Rahul
authors.initials: R
authors.lastname: Patri
authors.forename: Yili
authors.initials: Y
authors.lastname: Huang
authors.forename: Michael
authors.initials: M
authors.lastname: Liou
authors.forename: Aravinda
authors.initials: A
authors.lastname: Nanjundappa
authors.forename: Ramesh
authors.initials: R
authors.lastname: Daggubati
authors.forename: Samir
authors.initials: S
authors.lastname: Pancholy
authors.forename: Tejas
authors.initials: T
authors.lastname: Patel
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D017534:Radial Artery / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome; D014481:United States; D062666:Vascular Access Devices; D061205:Vascular Calcification / Q000175:diagnosis