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Cardiology Quiz

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Question 10
  
The cineangiogram of the patients saphenous vein graft to the RCA shows a subtotal lesion involving the ostium and very proximal portion of the aorto-graft anastamosis. Despite the critically stenosed lesion, brisk TIMI 3 flow is maintained. A degenerative 30% lesion is noted distal to the severe stenosis, in the proximal portion of the graft. Because of the critical stenosis, the patient's new onset angina and the nuclear stress test that showed reversible ischemia in the distribution of the RCA, a percutaneous intervention (PCI) is planned.
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     The angiogram was performed using a 6 French Judkins JR4 catheter. Which one of the following guiding catheters would you select to perform the PCI. Before you select the answer, click on the "label" button to obtain a still frame and note the orientation of the catheter tip to the ostium of the graft:

A. Judkins JR5
B. Amplatz AL1
C. Amplatz AR1
D. Multipurpose A2
E. Hockey stock

Please check the box that is the most likely correct answer.
Answer A 

    No, thiis is not the correct answer. Please click on the Retry button
Answer B  
    No, this is not the correct answer. Please click on the Retry button
Answer C 

    No, this is not the correct answer. Please click on the Retry button
Answer D

    You selected the correct answer.
        The cineangiogram shows that the graft is down-going. It would require a catheter that points downwards and be most likely to offer co-axial alignment while traversing the lesion with a guide wire and PTCA balloon. The Judkins, Amplatz and Hockey stick catheter have angled tips and thus not fulfil the above criteria. In contrast, the Multipurpos A2 catheter was felt to be the best option. The video below shows near perfect coaxial alignment achieved with the catheter. The guide wire and balloon easily crossed the lesion. However, beacuse of the tight lesion, flow is now sluggish secondary to obstruction by the 0.014" guide wire and PTCA balloon which are now across the lesion.

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Answer E 

    No, this is not the correct answer. Please click on the Retry button
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Question 10
  

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