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Objectives. We aim to present a new way to introduce reverse wire in crusade microcatheter-facilitated reverse wire technique to solve markedly angulated bifurcated lesions. Background. Markedly angulated coronary bifurcation lesions are still one of the considerable challenges of treatment with percutaneous coronary intervention especially with severe proximal stenosis. Microcatheter-facilitated reverse wire technique improved the efficacy of crossing a guide wire to such an extremely angulated complex targeted vessel. However, there has been a debate regarding what kind of curve was the best to introduce reverse guide wire in this technique. Methods. We analyzed 7 patients who were admitted to Fuwai Hospital and underwent antegrade wiring which failed. Crusade microcatheter-facilitated reverse wire technique with simple short tip one round curve was used successfully to solve in all 7 bifurcation lesions. We investigated the bifurcation lesion’s characteristics and details of the reverse wire technique procedures. Results. All 7 bifurcations exhibit both a smaller take-off angle and a larger carina angle and severe proximal significant stenosis. After having suitable size of balloon predilation, reverse wire with simple short distal one curve was delivered to distal segment of targeted vessel successfully. We performed all PCI procedures without any complications and no major adverse cardiac event was observed during hospitalization. Conclusions. In solving markedly angulated bifurcated lesions, especially with severe proximal stenosis, crusade microcatheter-facilitated reverse wire technique with simple short tip one curve is an effective and safe way of wiring.

Objective: To compare safety and efficacy between the radial and femoral approach for percutaneous coronary intervention (PCI) in patients aged 80 years and older. Method: Two hundred sixty-eight elderly patients (80–97 years old, 176 men) who underwent elective PCI between May 2003 and May 2007 were included in this study: the femoral (hereinafter referred to as the Femoral Approach Group) approach was used on 156 patients and radial (Radial Approach Group) on 112 patients. Clinical and procedural characteristics and the incidence of in-hospital major adverse cardiac events (MACE, including cardiac death, nonfatal myocardial infarction, and target lesion revascularization) were compared between the 2 groups. Results: Procedural success rate was similar and >95% for both approaches. The radial approach was associated with longer cannulation (3.0 ± 2.8 minutes vs. 2.0 ± 1.9 minutes, P < 0.001), fluoroscopy time (23 ± 15 minutes vs. 19 ± 12 minutes, P = 0.03) and higher rate of crossover to an alternative access site (9.8% vs. 3.8%, P = 0.02) compared with the femoral approach, while ambulation time (5 ± 2 hours vs. 20 ± 4 hours, P < 0.001), and rates of access site bleeding (2.7% vs. 9.6%, P = 0.004), hematoma (4.5% vs. 10.9%, P = 0.006), or any vascular complication (7.1% vs. 23.7%, P < 0.001) were significantly reduced with the radial approach as opposed to femoral. Multivariate regression identifies the radial approach (OR = 0.25, CI = 0.09–0.75) as an independent negative predictor of postprocedural vascular complications. Conclusion: When compared to the femoral approach, PCI with the radial approach significantly reduces rates of vascular complications in high-risk populations of patients aged 80 years and older. However, efficacy and procedural success rates were similar for both groups whereas cannulation and fluoroscopy time longer and puncture failure rate higher with the radial approach than femoral. (J Interven Cardiol 2012;25:513–517)

To compare safety and efficacy between the radial and femoral approach for percutaneous coronary intervention (PCI) in patients aged 80 years and older.Two hundred sixty-eight elderly patients (80-97 years old, 176 men) who underwent elective PCI between May 2003 and May 2007 were included in this study: the femoral (hereinafter referred to as the Femoral Approach Group) approach was used on 156 patients and radial (Radial Approach Group) on 112 patients. Clinical and procedural characteristics and the incidence of in-hospital major adverse cardiac events (MACE, including cardiac death, nonfatal myocardial infarction, and target lesion revascularization) were compared between the 2 groups.Procedural success rate was similar and95% for both approaches. The radial approach was associated with longer cannulation (3.0 ± 2.8 minutes vs. 2.0 ± 1.9 minutes, P0.001), fluoroscopy time (23 ± 15 minutes vs. 19 ± 12 minutes, P = 0.03) and higher rate of crossover to an alternative access site (9.8% vs. 3.8%, P = 0.02) compared with the femoral approach, while ambulation time (5 ± 2 hours vs. 20 ± 4 hours, P0.001), and rates of access site bleeding (2.7% vs. 9.6%, P = 0.004), hematoma (4.5% vs. 10.9%, P = 0.006), or any vascular complication (7.1% vs. 23.7%, P0.001) were significantly reduced with the radial approach as opposed to femoral. Multivariate regression identifies the radial approach (OR = 0.25, CI = 0.09-0.75) as an independent negative predictor of postprocedural vascular complications.When compared to the femoral approach, PCI with the radial approach significantly reduces rates of vascular complications in high-risk populations of patients aged 80 years and older. However, efficacy and procedural success rates were similar for both groups whereas cannulation and fluoroscopy time longer and puncture failure rate higher with the radial approach than femoral.