Balloon‐assisted tracking: A must‐know technique to overcome difficult anatomy during transradial approach

Abstract

BAT technique was useful to address the anatomical issues and tortuosities of radial, brachial, and subclavian vasculature during TRA.

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“…Their incidence may vary according to the available literature, starting from 8,8% [7,6], 13,8% [2], up to 22,8% according to Valsecchi et al [3]. They can be reason for procedural failure in 1-5% of the patients even in experienced operators` hands [4,9]. RAA include high bifurcating origin of the radial artery (high take-off radial artery) (Figure 1), radial artery loop (Figure 2 & 3), tortuosity (Figure 1), hypoplasia and stenosis.…”

“…RAA include high bifurcating origin of the radial artery (high take-off radial artery) (Figure 1), radial artery loop (Figure 2 & 3), tortuosity (Figure 1), hypoplasia and stenosis. In most cases, these anomalies can be overcome by using hydrophilic guiding wire and diagnostic 5F Judkins right catheter (JR 4) or even 4F Judkins right catheter, sometimes 0,014" hydrophilic coronary wire [1] and in rare cases by using so-called BAT technique ("balloon-assisted tracking"), a technique proposed by Dr. Tejas Patel et al [9]. Operators should be experienced in TRA and by using some simple maneuvers like push-and-pull technique and catheter rotation usually achieve a successful negotiation with the radial artery ( Figure 4).…”

Zastosowanie techniki BaLloon Assisted Sliding and Tracking of GuideLiner (BLAST-G) do skutecznego umieszczenia stentu w zwapniałej zmianie o krętym przebiegu — opis przypadku

“…Also, inflating a balloon distal to the target lesion in normal vessel may cause local trauma, that might require stent extension, thus has a potential to increase a risk of in-stent restenosis. In balloon assisted tracking (BAT) technique [6,7], the inflated balloon protrudes partially beyond GuideLiner catheter's tip and the whole assembly, i.e. GuideLiner-balloon moves over the wire.…”

“…We then introduced 5.6F GuideLiner (mother-in-child) over the runthrough guide wire and pushed its tip beyond the guiding catheter, but it failed to budge further across the lesion ( Figure 2). We tried balloon assisted technique [5,6], but because of razor effect, it also failed ( Figure 3). We then pushed 2.5 × 10 mm balloon (Sapphire, OrbusNeich Netherland) little further from GuideLiner tip and inflated up to 3 atm pressure.…”

Transradial Sheathless Approach for PCI

“…One solution has been to first introduce a conventional sheath followed by a standard 0.035-inch wire and then advance the guide over a small diameter diagnostic catheter or a guiding sheath dilator. An alternative has been to advance over a coronary wire and a partially inflated coronary balloon at the tip [35,36]. Whilst possible, these solutions are likely to be technically challenging, particularly when cannulating small radial arteries.…”