By Satoshi Takeshita
The pursuit of miniaturization of percutaneous coronary intervention (PCI) devices in efforts to deliver less invasive angioplasty is part of the changing times. In fact, in the early years of PCI, 9-10 Fr guiding catheters were used, while 6 Fr guiding catheters have become established as the current standard.
When treating complex coronary lesions, however, the backup support of a 6 Fr guiding catheter is often insufficient. To overcome this disadvantage, several techniques have been proposed, which include active/passive guiding-catheter support, wire support, and anchor-balloon technique. Among these, the 4-in-6 mother-child technique appears most useful for successful stent delivery. (1,2) In fact, the 4-in-6 technique could provide success in >90% of cases in which the conventional techniques had failed. (1) It is important to note, however, that for the remaining ~10% of cases, stent delivery still failed due to inability to advance the child catheter.
In this issue of the Journal of Invasive Cardiology, we introduce a case in which a second guidewire was used as a buddy wire to further advance the child catheter. (3) In this case, stent delivery had failed despite using various PCI techniques. Even with the standard 4-in-6 technique, stent delivery failed due to inability to advance the child catheter. However, after placement of the second guidewire, the child catheter could be further advanced toward the lesion. As a result, the stent was successfully delivered. At present, the 4-in-6 with a buddy wire, is the most promising technique to achieve successful stent delivery.
- Takeshita S, Shishido K, Sugitatsu K, Okamura N, Mizuno S, Yaginuma K, Suenaga H, Tanaka Y, Matsumi J, Takahashi S, Saito S. In vitro and human studies of a 4F double-coaxial technique (“mother-child” configuration) to facilitate stent implantation in resistant coronary vessels. Circ Cardiovasc Interv. 2011;4:155-161.
- Takeshita S, Takagi A, Saito S. Backup support of the mother-child technique: Technical considerations for the size of the mother guiding catheter. Catheter Cardiovasc Interv. 2012;80:292-297.
- Uchida Y, Nakashima H, Takeshita S. Modified mother-child technique using a buddy wire. J Invasive Cardiol. 2014;26(5):E52-E53.
A Selection of recent JIC Articles on PCI in Complex Coronary Lesions
- Tobita K, Takeshita S, Saito S. The 4-in-5 mother-child technique: 5 Fr transradial coronary intervention for complex lesions using a 4 Fr child catheter. J Invasive Cardiol. 2013 Aug;25(8):406-8.
- Williams PD1, Eichhöfer J, Mamas MA, Arnous S, Fath-Ordoubadi F, Fraser D. Transradial intervention via large-bore guide catheters: a study of coronary bifurcation disease treatment using the crush technique. J Invasive Cardiol. 2013 Sep;25(9):455-9.
- Isaaz K1, Mayaud N, Gerbay A, et al. Long-term clinical outcome and routine angiographic follow-up after successful recanalization of complex coronary true chronic total occlusion with a long stent length: a single-center experience. J Invasive Cardiol. 2013 Jul;25(7):323-9.