Radial loops- Difficult radial, subclavian and aortic anatomy: step-by-step, cases, perforation

Radial loops/tortuosity/high branching:
0:00 Radial loops, basic technique: 0.014”-0.018" wire and Glidecath technique
11:52 Radial loops: 2 modifications of the basic technique
13:53 3 types of difficult radial anatomy
18:10 BAT technique (balloon-assisted tracking)
24:52 Radial perforation: how to handle it
29:10: More cases of radial/brachial loops
Subclavian/aortic loops and angulations:
34:30 Difficulty at the subclavian level: wire goes repeatedly in the carotid
37:33 How to move catheter from descending to ascending aorta
39:21 Innominate subclavian loops
41:44 Sharp aortic-innominate angulation
44:26 How to keep a wire in during difficult coronary angiography+ case illustration
47:08 Severe radial spasm and catheter entrapment

[@vvasavvat]

Very nice talk !!!

[@Docsammy]

Great lecture as usual Dr. Hanah. BAT technique is great. I also use 5F 125 MPA inside the 6F guide (mother daughter technique). I also use the MPA instead of the glide catheter to manipulate tortuosity. The cordis made MPA are very soft tip and the bend is also friendly for radial and brachial.

[@eliashanna8248]

That is a great tip. Thank you!

[@Nikesnipe]

Awesome Info!

[@munzerhamad2340]

thanks you prof....glidewire is Teuromo wire !!

[@mohammadaminemami6352]

Very nice and thanks for your sharing

[@kashifali7742]

Thank you so much. I have a question. If we keep the 0.018 or 0.035 wire inside the catheter while we inject contrast, is there any risk of bubble formation within the catheter?

[@eliashanna8248]

Good point. There is a risk of bubble formation if you suck hard when you are aspirating the catheter. The lumen of the catheter being now smaller, you have to aspirate gently rather than vigorously before flushing. You should still aspirate well, at least 6-7 ml, to eliminate bubbles but also clot (as there is a higher risk of clot formation), but be gentle.
The bigger risk I see is clot formation over the wire, especially that the lumen is now smaller. Hence the importance of being anticoagulated while doing injections with a wire in place. Usually, for that purpose, I use the standard heparin dose that I use anyway in radial procedures (5,000 units or 50 units/kg)