经桡动脉穿刺冠状动脉造影后即刻经桡动脉介入治疗

目的探讨冠心病心绞痛患者经桡动脉穿刺冠状动脉造影术后即刻选择经桡动脉行冠状动脉介入治疗的可行性、并发症以及近期疗效。方法选择临床诊断为冠心病心绞痛经桡动脉造影显示明确的冠状动脉病变后即刻采取经桡动脉介入治疗(PCI)的患者117例(桡动脉组),与同期经股动脉途径造影后即刻PCI者(股动脉组,共409例)进行比较,分析两组靶血管病变特征、疗效和并发症,并随访术后1月内心绞痛复发、心肌梗死、死亡等主要心血管事件的发生率。结果桡动脉组PCI成功率为94.0%,与股动脉组(97.6%)相比无明显差异(P>0.05)。桡动脉组造影显示明显病变(管腔狭窄程度≥70%)的血管数量累计为210支,其中182支作为靶血管进行了成功的PCI,病变血管的血运重建率为86.7%,低于股动脉组(93.4%),差异具有显著性(P<0.01)。而且成功PCI者中慢性闭塞病变的所占的比例也明显低于股动脉组,差异具有显著性(P<0.05)。桡动脉组术后与穿刺有关的总的并发症的发生率明显低于股动脉组(P<0.01)。术后平均卧床时间和平均住院天数均明显短于股动脉组。随访PCI术后1个月期间主要心血管事件两组之间无明显差异(P>0.05)。结论经桡动脉穿刺冠状动脉造影术后即刻行冠状动脉介入治疗的成功率较高,并发症少,具有可行性。但对于复杂病变选择经股动脉途径PCI     

经桡动脉途径行左主干介入治疗的有效性与安全性研究

目的:探讨经桡动脉途径行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)治疗的左主干病变的有效性及安全性。方法:选择2008年1月1日至2010年12月31日间,在我院经桡动脉途径使用6F指引导管行PCI治疗的左主干病变93例患者。记录患者住院期间和随访期间的全因病死率及症状驱动的左主干血运重建率。结果:男性占62.4%,平均年龄(62.5±15.47)岁。左主干病变狭窄程度(76.4±17.63)%,单纯开口部病变18.3%,单纯体部病变11.8%,累及远端分叉病变69.9%,Syntax积分为(23.5±12.33)分。均成功置入支架,共124枚药物洗脱支架(DES),平均直径(3.43±0.48)mm,平均长度(18.3±10.48)mm,单支架术39.8%,双支架技术共60.2%。住院期间无死亡病例。93例患者平均随访23.5个月,随访率100%,随访期间病死率3.2%。随访过程中Syntax评分低危组的患者发生终点事件的比例(4.9%)显著低于高危组(11.9%),差异具有统计学意义(P<0.001)。结论:经桡动脉6F指引导管处理左主干病变安全可行,能取得良好的近远期效果,其中Syntax评分<33分的患者预后更好。     

经桡动脉用7.5 F无鞘指引导管完成冠状动脉复杂病变介入治疗的初步经验

目的：总结北京友谊医院心血管病中心心内科使用无鞘指引导管（日本ASAHI）经桡动脉完成的60例冠状动脉复杂病变患者介入治疗的经验和体会。方法回顾分析患者的临床资料、影像资料以及术后恢复情况,对无鞘指引导管的使用特点进行总结分析。结果60例患者均为复杂冠状动脉病变,其中,慢性完全闭塞病变（CTO）13例,迂曲合并钙化病变17例,左主干病变7例,分叉病变32例（包括左主干病变7例和同时合并CTO病变2例）。行经皮冠状动脉介入治疗（PCI）,成功57例,失败3例,成功率95.0%。患者使用7.5 F的无鞘指引导管,均顺利通过桡动脉到位。左冠状动脉使用的无鞘指引导管型号依次为：JL3.5/4.0（44例）,AL1.0（3例）, SPB4.0/3.5（2例）,PB4.0（2例）;右冠状动脉：JR3.5/4.0（9例）。13例CTO病变使用的无鞘指引导管型号依次为：JL3.5/4.0（8例）,PB4.0（2例）,AL1.0（2例）,JR4.0（1例）;17例迂曲钙化病变：JL3.5/4.0（8例）,JR3.5/4.0（6例）,SPB3.5/4.0（2例）,AL1.0（1例）;32例分叉病变使用的无鞘指引导管型号均为JL3.5/4.0或JR3.5/4.0。结论经桡动脉使用7.5 F无鞘指引导管有良好的通过性,且导管管腔大、管壁厚、支撑力强,能胜任大多数分叉病变的双支架技术和对吻球囊技术,适合CTO、迂曲钙化病变等复杂病变的介入治疗。     

血管扩张药物干预下经桡动脉入径应用7 Fr指引导管治疗冠状动脉分叉病变的可行性与安全性

目的评价血管扩张药物干预下经桡动脉入径应用7 Fr指引导管治疗冠状动脉分叉病变的可行性与安全性。方法入选2012年1月至2014年7月经冠状动脉造影示分叉病变且适合行经皮冠状动脉介入治疗(PCI)的患者,随机分成经桡动脉6 Fr指引导管组(6 Fr组)和7 Fr指引导管组(7 Fr组)。对比观察两组患者动脉鞘管置入成功率、手术操作成功率、完成PCI操作时间、X线透视时间和对比剂用量。随访住院期间、术后30 d内的入径血管相关并发症及主要不良心血管事件。结果共纳入229例冠状动脉分叉病变患者,其中6 Fr组113例,7 Fr组116例。两组患者年龄、性别、体重指数、危险因素、临床特征、住院时间等方面比较,差异均无统计学意义。6 Fr组行常规鞘管置入;7 Fr组先行6 Fr鞘管置入,在充分局部麻醉并给予血管扩张药物的基础上更换为7 Fr动脉鞘管。6 Fr组有4例患者换用7 Fr指引导管进行手术操作;7 Fr组均成功完成PCI术,无患者转至6 Fr组。与6 Fr组相比,7 Fr组完成PCI操作时间更短[(52±9.2)min比(60±10.7)min,P0.0001],球囊应用数量更少[(2.9±0.6)枚比(3.2±0.4)枚,P=0.002],X线透视时间更短[(24±8.2)min比(28±9.4)min,P=0.02]。两组对比剂用量比较,差异无统计学意义[(152±25.8)ml比(158±23.5)ml,P=0.20]。住院期间6 Fr组和7 Fr组前臂血肿[4/113例(3.5%)比6/116例(5.2%),P=0.76]及桡动脉闭塞[4/113例(3.5%)比9/116例(7.8%),P=0.26]的发生率分别比较,差异均无统计学意义。术后30 d随访,两组桡动脉闭塞的发生率相似[2/99例(2.0%)比4/103例(3.9%),P=0.70],且均未见掌弓循环障碍的临床表现。结论在血管扩张药物的作用下,桡动脉血管内径增大,可容性增强,利于7 Fr指引导管分叉病变治疗操作,安全可靠,且并未增加血管并发症发生率。     

Judkins Left指引导管在起源异常的右冠状动脉经桡动脉行经皮冠状动脉介入治疗中的应用

目的评价Judkins Left系列指引导管在起源于左冠状窦的右冠状动脉经桡动脉行经皮冠状动脉介入治疗（PCI）中应用的安全性和有效性。方法 11例患者起源于左冠状窦的右冠状动脉存在狭窄或闭塞病变,均采用右侧桡动脉穿刺,选择JL 3.5或JL 4.0指引导管行右冠状动脉PCI,根据病变情况必要时应用双导丝技术或5进6子母导管技术增加指引导管同轴性和支撑力。慢性闭塞病变常规应用微导管增加指引导丝支撑力,以便于更换导丝。观察手术成功率、并发症和近期随访结果。结果 11例患者中,3例为右冠状动脉慢性闭塞病变,8例为严重狭窄病变,同时合并左冠状动脉病变。所有患者均使用Judkins Left系列指引导管经桡动脉成功完成右冠状动脉PCI,7例应用JL 3.5指引导管,4例应用JL 4.0指引导管。2例在Judkins Left系列指引导管基础上应用5进6子母导管,其中包括1例右冠状动脉慢性闭塞病变;4例应用双导丝技术增加支撑力。3例慢性闭塞病变在微导管支持下均成功行PCI,其中1例先应用双导丝技术、后5进6子母导管增强支撑力。所有患者均成功置入药物洗脱支架,共置入支架19枚,每例右冠状动脉置入支架1~3（1.7±0.7）枚,置入支架长度为18~99（44.1±23.8）mm。术中所有患者均未出现冠状动脉穿孔、栓塞或夹层等并发症,手术成功率100%。住院期间无心脏压塞及支架血栓等并发症。术后临床随访6~12个月,无死亡及心肌梗死等不良心血管事件发生。结论对于右冠状动脉起源于左冠状窦病变,经右侧桡动脉途径,可以选择Judkins Left系列指引导管行PCI,支撑力不够时,可辅以其他增加支撑力的技术,如微导管技术、双导丝技术、子母导管技术等完成手术操作。     

经桡动脉途径介入术后的桡动脉作为桥血管用于冠状动脉搭桥术可行性分析

目的评估经桡动脉途径介入术后的桡动脉作为桥血管应用于冠状动脉搭桥术(CABG)的可行性。方法回顾性分析168例应用桡动脉作为桥血管行CABG术患者的临床资料。根据使用是否经桡动脉途径介入术后的桡动脉作为桥血管,将168例患者分为介入组(76例)、非介入组(92例),比较两组患者的随访结果。结果两组患者临床资料比较无统计学差异(P0.05)。与介入组比较,非介入组桡动脉桥血管通畅率显著增高,心肌缺血事件发生率显著降低,差异有统计学意义(P0.05)。两组术侧前臂切口感染、拇指麻木、骨筋膜室综合征等桡动脉获取相关并发症发生率无显著差异(P0.05)。结论选择非经桡动脉途径介入术后的桡动脉作为桥血管可提高桥血管通畅率并改善CABG术的临床效果。     

Long-tip guiding catheter: Successful and safe for left coronary artery angioplasty

A long-tip guiding catheter was designed for angioplasty of the left coronary artery. Principal factors of guiding catheter function were identified, and the catheter's shape was designed to utilize them efficiently. Emphasis was placed on an overbent secondary curve (150–180°) for more precise catheter control. The distal tip of the catheter is 2 cm long in the 4.0 size and the primary bend is shallow, ～20%. A 1.5 cm long segment between the secondary and tertiary curves enhances stability and support. Catheter performance was studied during procedures on 90 patients; 89 patients underwent coronary artery angioplasty and one patient underwent diagnostic angiography. The success rate for angioplasty was 95% with no major complications. Mild pressure damping occurred in 18 patients, and mild catheter displacement from the left main coronary artery occurred in 24 patients. Catheter support was judged as excellent to very good in 82 patients. Judkins or Amplatz catheters were not required during this study. The observed disadvantages of the long-tip catheter were the risk of catheter buckling up during advancement into the left main coronary artery and, perhaps, a higher risk of pressure damping. Superselective engagement of the catheter in the left anterior descending or circumflex arteries may be a problem when the left main coronary artery is very short. This study showed the long-tip catheter to be safe and highly successful for angioplasty of the left coronary artery.     

短头Amplatz left指引导管在经桡动脉右冠状动脉复杂病变治疗中的安全性及可行性

目的:探讨短头Amplatz left(SAL)指引导管在经桡动脉右冠状动脉(RCA)复杂病变经皮冠状动脉介入治疗(PCI)中的安全性和可行性。方法:入选2013年5月至2015年3月经择期冠状动脉造影证实为RCA复杂病变的冠心病患者120例,随机分为SAL组和Amplatz left(AL)组各60例。观察并比较两组PCI成功率、PCI手术时间、指引导管到位成功率、指引导管到位平均耗时、X线透视时间、造影剂用量等。记录并比较两组患者PCI术中并发症的发生率,随访术后30d主要不良心血管事件(MACE)。结果:两组PCI成功率、指引导管到位率、指引导管到位平均耗时、PCI手术时间、造影剂用量等均无显著性差异(P0.05)。SAL组应用5in 6子母导管比例(16.7%对3.3%,P=0.033)、球囊锚定技术比例(25.0%对8.3%,P=0.027)及导丝数量(3.1±0.6对2.9±0.3,P=0.021)均高于AL组。SAL组术中并发症的发生率明显低于AL组(10.0%对26.7%,P=0.034)。两组术后30d内MACE发生率无显著差异(P0.05)。结论:SAL指引导管的支撑力不及AL指引导管,但SAL导管同样能够完成大多数RCA复杂病变的治疗,且能够降低PCI术中并发症的发生率。     

SAL指引导管使用56例初步经验

目的:初步总结短头AL（short amplatz left，SAL）指引导管（guiding catheter，GC）的使用经验，评价SAL GC的使用特点及安全性。方法: 回顾分析总结我科56例使用SAL导管行右冠状动脉（RCA）介入治疗患者的影像特点，操作过程及最终结果。56例患者中慢性完全性闭塞（CTO）病变29例；病变迂曲8例；病变明显钙化10例；迂曲并发钙化5例；病变位于RCA远端且近中段迂曲14例。结果: 56例患者中SAL GC成功到位53例（95%），3例不能到位。53例使用SAL GC完成PCI手术，PCI成功46例，成功率87%，失败7例（13%），均为CTO病变；CTO病变的成功率为76%（22/29），失败原因为导丝不能通过5例，术中过敏反应1例，心室颤动1例，均顺利中止手术。56例中无1例发生RCA开口或近端夹层，也无右窦内夹层发生。结论: SAL GC操作简单，容易到位，适合大部分RCA复杂病变，具有良好的安全性。     

Amplatzing a 6 Fr Judkins right guiding catheter for increased success in complex right coronary artery anatomy.

Stent supported angioplasty is being performed in an increasing number of patients and, with advances in device technology, more morphologically complex lesions are being treated. In such a setting, it is extremely important to deliver the device to the target lesion. We describe a new technique that allows successful stent delivery in complex right coronary anatomy using the Judkins right guiding catheter. Cathet Cardiovasc Intervent 2001;53:405-409.     

经桡动脉冠状动脉介入诊疗术后桡动脉损伤的影响因素分析

目的:探讨接受桡动脉冠状动脉介入诊疗患者术后,桡动脉损伤的情况及影响因素。方法:入选2008年5月至2009年10月,于安贞医院就诊拟行冠状动脉造影的患者966例,随机分为4F动脉鞘管组和6F动脉鞘管组。分析两组患者桡动脉并发症〔如桡动脉闭塞(RAO)、桡动脉痉挛(RAS)等〕的发生率,通过多因素Logistic回归分析RAO的危险因素。结果:4F鞘管组和6F鞘管组中,RAO(0.8%vs.2.9%,P=0.018),RAS(1.2%vs.3.5%,P=0.021),桡动脉内膜增厚率(1.0%vs.4.1%,P=0.002),前臂小血肿(0.6%vs.2.5%,P=0.020),患肢疼痛(1.2%vs.4.1%,P=0.006)等的发生率及压迫止血时间〔(4.62±0.98)vs.(6.36±0.93)h,P<0.001〕,4F组均低于6F组,差异有统计学意义。两组患者均未出现前臂大血肿、假性动脉瘤、动静脉瘘及骨筋膜室综合征。RAO经多因素回归分析显示,大尺径动脉鞘管、术后压迫止血时间过长是发生RAO的危险因素。结论:经桡动脉PCI中选择小直径动脉鞘管,避免术后长时间的压迫止血有利于降低RAO的发生率,同时减少桡动脉内膜损伤,提高患者舒适度。     

老年患者经桡动脉介入治疗术后急性桡动脉闭塞危险因素分析

目的:观察老年患者(≥60岁)接受桡动脉冠状动脉介入诊疗(TRI)术后桡动脉急性闭塞(RAO)的发生率,并探讨影响老年患者TRI术后发生RAO的相关因素。方法:选择2006年8月至2009年2月,于北京安贞医院12病房择期TRI≥60岁的老年患者1 256例,根据术后是否发生RAO分为正常组和RAO组,通过多因素Logistic回归分析与RAO有关的危险因素。记录手术相关参数,包括桡动脉穿刺次数、鞘管型号、手术时间、术中肝素用量及术后桡动脉压迫止血时间。疑有桡动脉闭塞的患者通过多普勒超声确诊。结果:1.1 256例TRI患者急性RAO发生率2.2%(28/1256例)。与正常组相比,RAO组患者中女性、糖尿病和既往行TRI患者的比例较高,RAO组术中平均肝素用量明显低于正常组〔(3 826±523)IU vs.(7 425±980)IU,P=0.008〕,术后压迫时间长于正常组〔(378.9±35.4)min vs.264.7±43.2)min,P=0.003〕,且RAO组患者应用7F动脉鞘的比例较高(10.7%vs.1.9%,P=0.029);Logistic回归分析显示,7F动脉鞘管、肝素用量偏低及术后桡动脉压迫时间过长,是影响RAO发生的独立危险因素。结论:老年患者TRI术中选择尺寸合适的动脉鞘管、足够强度的抗凝治疗、避免术后过长时间的压迫止血等均有利于减少RAO的发生。     

5F共用型造影导管在经桡动脉径路冠状动脉造影中的应用

目的　探讨 5 F共用型造影导管在经桡动脉径路冠状动脉造影中的应用价值。方法　选择经桡动脉径路行冠状动脉及左心室造影患者 89例 ,按其造影时首选 5 F Judkins型造影导管或 5 F共用型造影导管 ,分为Judkins型组 (n=4 8)和共用型组 (n=4 1)。对比两组手术成功率、X线透视时间和手术操作时间。结果　共用型组中 39例 (95 .1% )经桡动脉径路行冠状动脉及左心室造影成功 ,Judkins型组中 4 4例 (91.7% )造影成功 ,共用型组的造影成功率明显高于 Judkins型组 (P <0 .0 1)。Judkins型组的冠状动脉及左心室造影平均 X线透视时间和手术操作时间分别为 (7.5± 5 .5 )和 (30 .8± 2 0 .1)分钟 ;共用型组分别为 (5 .4± 3.4 )和 (2 4 .2± 10 .4 )分钟 ,均少于Judkins型组 (P <0 .0 1)。结论　使用较小直径造影导管经桡动脉径路施行诊断性冠状动脉造影 ,术后不需严格卧床 ,患者损伤小 ,止血方便 ,血管并发症少 ,可作为某些经选择病例的首选径路。合理选择适于桡动脉径路的造影导管 ,对提高手术操作的便捷性、安全性 ,以及保证造影质量至关重要     

Evaluation of a new 9F guiding catheter for directional coronary atherectomy

Large lumen guiding catheters (9.5 to 11 French) are currently required to perform directional atherectomy. These rigid guiding catheters require modifications of usual techniques for manipulation and can induce ostial trauma and peripheral vascular complications. A new type of 9 French guiding catheter (Vista Brite tip, Cordis, Miami, FL) with an inner diameter of 0.098 inch and capable of accommodating atherectomy catheters (SCA-EX) was evaluated. In this preliminary study, 31 consecutive patients were included. Primary success was obtained in 27 (87%); no ostial trauma and only two minor groin hematomas were observed. After exchange with a conventional 10F guiding catheter, because of poor back-up, two of the four failures were successfully treated by DCA. In conclusion, these new 9F guiding catheters provide a useful alternative to currently available guiding catheters for DCA. Nevertheless, new shapes with better back-up are necessary to improve the primary success rate. © 1996 Wiley-Liss, Inc.     

The use of a guide catheter extension system as an aid during transradial percutaneous coronary intervention of coronary artery bypass grafts

Aims : Prior coronary artery bypass graft (CABG) surgery is one of the main predictors of failure of transradial PCI. Frequently this is due to difficulty in graft cannulation and/or poor backup support. In addition to Proxis's? embolic protection role, the Proxis?, Heartrail?, and GuideLiner? guide catheter extension devices have all been shown to facilitate coronary intervention by increasing backup support and aiding stent delivery. We describe our institution's experiences using these devices to aid transradial graft intervention. Methods : Between October 2007 and March 2010, the utility and safety of these devices were assessed in consecutive transradial graft intervention procedures. Proxis? cases used for proximal protection alone were excluded. Deep intubation was defined as an intubation depth of ≥2cm. Results : Guide catheter extensions were used in 33 of 41 transradial graft interventions identified. Proxis? was used for proximal protection alone in 3 cases, leaving 30 cases as the study group (Heartrail? n = 18, GuideLiner? n = 3, Proxis? n = 9). In all study cases procedural success with final TIMI‐3 flow was achieved. Guide catheter extensions were used to aid during graft cannulation (n = 11), to improve backup support via deep intubation (n = 26) and as an adjunctive aspiration device (n = 11). Filter‐based distal embolic protection devices were used in 11/21 Heartrail? and GuideLiner? cases. Deep intubation depths ranged from 30 to 138 mm (mean 61 mm) with no complications related to deep intubation seen. Conclusions : The use of guide catheter extension systems facilitated transradial graft intervention via several mechanisms including aid to graft cannulation, increasing backup support, and as an adjunctive aspiration device. © 2011 Wiley Periodicals, Inc.     

New techniques for guiding catheter management during directional coronary atherectomy

Directional coronary atherectomy (DCA) is an important advance in the mechanical revascularization of stenotic coronary arteries. The bulky nature of the DCA device has necessitated the use of guiding catheter designs that are more cumbersome to use than balloon angioplasty guiding catheters. Because engagement of coronary artery ostia with the currently available DCA guiding catheters is often difficult and because DCA guiding catheters significantly “relax” and reshape during the atherectomy procedure, angiography using these guiding catheters before and after atherectomy can be suboptimal. A new technique for angiography during atherectomy using long Judkin's diagnostic catheters inserted through the existing DCA guiding catheters is described. This technique can be used for optimal visualization of the coronary arteries with minimal use of contrast before and after sessions of atherectomy and also can be used to help engage the DCA guiding catheters. Some improvements in the design of guiding catheters for DCA are suggested. © 1993 Wiley-Liss, Inc.     

Retrieval of directional coronary atherectomy guiding catheter with angioplasty balloon catheter

Directional coronary atherectomy (DCA) has been shown to be a safe and effective treatment for occlusive coronary artery disease. We report a case of an atherectomy guiding catheter severing in two with successful retrieval of the dislodged segment by an integrated angioplasty balloon catheter system. © 1995 Wiley-Liss, Inc.     

Feasibility of transradial coronary angiography and intervention using a single Ikari left guiding catheter for ST elevation myocardial infarction

Background: Transradial coronary intervention (TRI) has been widely adopted in ST elevation myocardial infarction (STEMI) patients but there is limited literature on the use of a single catheter for both diagnostic angiography and intervention. We aim to evaluate the feasibility and outcomes of TRI with a single Ikari left (IL) guiding catheter in STEMI patients. Methods: This is a retrospective study of 362 consecutive STEMI patients from August 2007 to December 2008. We assessed the feasibility of TRI with a single IL and compared this strategy with conventional transfemoral intervention (TFI) on the following outcomes: (1) door to perfusion time, (2) total procedural duration, (3) total fluoroscopy duration, and (4) major adverse cardiac events (MACE) by intention to treat analysis. Results: TRI was attempted in 185 patients. There were no failed radial cannulations. Overall success rate of primary TRI with a single IL was 96.9% and there were only 2 failures that required conversion to TFI. Compared to TFI, TRI with IL tended to a shorter median door to perfusion time, 90 (IQR 76.0 ? 119.5) versus 98 (IQR 80.8 ? 120.5) minutes (P = 0.07) and a shorter median procedure duration of 34 (IQR 27.0 ? 45.0) versus 37 (IQR 28.0 ? 49.3) minutes (P = 0.06). The median fluoroscopy duration was longer in the TRI group. MACE were comparable between the 2 groups. Conclusion: In experienced centers, TRI with a single IL catheter for STEMI is a feasible and effective approach and outcomes are comparable to conventional TFI. (J Interven Cardiol 2012;25:235–244)     

Double loop guiding catheter: A primary catheter for angioplasty of the right coronary artery

Double loop guiding catheters have been used for percutaneous transluminal coronary angioplasty (PTCA) of the right coronary artery (RCA) in 42 consecutive cases. A catheter with a 90- degree primary curve was used when the proximal RCA had horizontal or inferior orientation. When the proximal segment of the RCA was oriented superiorly (shepherd's crook), the catheter with a 75-degree primary curve was used. Catheters were fabricated with short (1.5 cm) or long (2.3 cm) (USCI, C.R. Bard, Inc., Billerica, MA) distal tips. Short-tip catheters were satisfactory in the majority of cases. When the RCA had a complex course and more backup was necessary or when the ascending aorta was wide, long-tip catheters were found to be the best choice. Angioplasty of 49 lesions was attempted in 42 consecutive patients. In 39 patients successful dilatation was achieved (93%). In three patients the procedure was unsuccessful. In one patient, the lesion could not be crossed with the guidewire despite an excellent backup. In another patient, two of three stenoses were dilated successfully; the distal lesion was crossed with a guidewire but could not be crossed with the balloon catheter in spite of a good backup. The lack of a satisfactory engagement and inadequate backup were responsible for the failure in only one patient. There were no complications related to these guiding catheters. We conclude that double loop guiding catheters are safe and can be the primary choice in all right coronary angioplasties. These catheters provide an excellent backup with consequent high success rate.