Review of radial catheter techniques: case illustrations + troubleshooting (what is the next step?)

**May also review my other talks related to coronary engagement and catheter manipulations**
0:00 Ascending aorta access and left coronary engagement:
0:00 Get from descending to ascending aorta (R or L radial). Next steps?
06:06 and 18:03 Catheter flips out onto the ascending aorta. Next steps?
08:25 Too sharp ascending aortic angle. Next steps?
12:50 Review of general LCA engagement (case illustrations)
15:39 Critical point in LCA engagement
21:30 Advanced case of sharp innominate-to-aorta angulation. Next steps?
25:25 LCA maneuvers in difficult cases: above vs below
31:00 Go from LCx to LAD. Which maneuver?
33:41 Catheter disengages with each injection. Next steps?
35:38 Guide engagement and switching between various techniques of LCA engagement
37:20 Four additional tips
42:48 RCA engagement troubleshooting. Next steps? Standard takeoff and anterior takeoff (48:28)
52:20 Left subclavian/LIMA troubleshooting. Next step if you cannot engage the subclavian? Next steps if you cannot advance a wire in the subclavian?
58:29 LV access
1:02:08 Radial wire goes into the right carotid. Next steps?

[@Nikesnipe]

Thanks so much Greetings from Germany

[@eliashanna8248]

Thank you for all of your comments! Greetings to you and to Germany

[@aymankhaled1065]

the best video i have watch on the youtube in my whole life
dr Elias please keep uploading your knowledge for us

[@m.s3815]

Thank you very much dear Dr Hanna.
Another great presentation. I look forward to your next videos with great enthusiasm and interest. Especially in the cases of complex pci and CTO and structural procedures.

[@mali25177]

Thank u so much. Great talk

[@abdallahelmesalamy3650]

Thank you very much dear Dr Hanna.

[@ratheraltaf541]

Thank you so much sir

[@mostabdrabou]

thanks sir
this is really very helpful
you are a great teacher indeed

[@munzerhamad2340]

Thank you very much ....

[@moayadaffani2933]

Thank you very much

[@areenal-taie6836]

Thanks a lot
Please continue

[@ratheraltaf541]

❤❤❤

[@suchismitabhuyan2716]

Nice presentation...what should we do if d guide disengages frequently while advancing stent?

[@jamalelouazzani7591]

Thank you very much dear Dr Hanna.
would you recommend us a book of coronary catheterization for beginners

[@Spacialfart]

Thank you for your interesting work, really helpful for beginners.
Are you teaching left coronary catheterization in RAO 30° ? In my cathlab, we always do it from face view (0°/0°). What's the best ?

[@eliashanna8248]

We do coronary engagement in LAO 30 view, which, as you see in minute 38:10 and in my other talks on coronary engagement, is the best view to lay out the origins of LCA and RCA (LAO is close to orthogonal to their origins). I use RAO for engagement of a RCA that has anterior takeoff, as RAO will lay out RCA better in this case, as explained. I do not use AP for engagement; AP would generally be harder, as it is not quite as orthogonal to the coronary ostia.

[@adityadewantohendrani9648]

Great talk sir. For your future video, could you give tips and trick how to cross bicuspid aortic valve and bioprosthetic aortic valve into LV? Is crossing mechanical aortic valve safe? Thank you Dr.Hanna

[@eliashanna8248]

Great questions, thank you. I like them. When crossing any severe AS, it is often useful to perform small aortic root angiographic (5-10 ml), usually in LAO, to delineate the aortic valve hole and know where to aim your catheter/wire.
-Regarding bicuspid severe AS: it is often more difficult to cross bicuspid AS than tricuspid AS, as the hole is eccentric. 80% of bicuspid valves have fusion of the right and left cusps, and ~20% have fusion of the right and noncoronary cusps. In the first scenario: LAO view, which normally spreads apart the right and left cusps, is not likely to help, as the hole is rather in an antero-posterior plane, not right-left plane. Thus, RAO view is instead helpful and separates the anterior cusp (fused R+L) and the posterior cusp (NC). Do root angiography in RAO to delineate the hole, and may consider further angulations, eg RAO caudal.
If you do aortic angiography in LAO, you will often see one domed cusp rather a separation between 2 cusps.
-In relation to the above, during standard left coronary engagement in pts with bicuspid valve of the 1st type, you will not see nor seek my beloved “jump” from right to left cusp (the one I describe at 12:50). Rather, you will see a subtle catheter movement across the valve from right to left, not a typical jump.
-Regarding bioprosthetic AS: the anatomy is variable and the hole may be better seen in a right-left plane in some, vs. ant-post plane in others. Do root angiography in LAO and RAO and may even consider a bit of cranial and caudal angles if difficulty persists.
-For mechanical valves, crossing is not safe and not recommended: risk of catheter entrapment + it frequently induces significant AI which falsifies measurements. I have unintentionally crossed many mechanical valves (eg, while engaging RCA) with no issue, but it should not be done intentionally. Transseptal puncture is required for invasive LV assessment, if absolutely needed. There are several case reports of using FFR wire across the aortic mechanical valve; this may be safe but data is limited.

[@medikondaparameshwarareddy9830]

Great talk sir, can you please make a video on fluoroscopic guided transeptal puncture? Thank you.

[@m.s3815]

Could be very intresting

[@mohammadatefcardio8655]

Thank you, Dr. Elias. I really appreciate your amazing effort, and hope you make more videos and more books. I would like to ask you if you have an account on Facebook or telegram?

[@eliashanna8248]

Thank you for your kind words. I do not use social media :).