Use of a single Q guide catheter for complete assessment and treatment of both coronary arteries via radial access during acute ST elevation myocardial infarction: a review of 40 consecutive cases.

BACKGROUND

It is normally necessary to use more than 1 coronary catheter in primary percutaneous coronary intervention (PPCI) for ST elevation myocardial infarction (STEMI). We explored the utility of a single guide catheter (Q) strategy for complete coronary assessment and treatment in PPCI.

METHODS

Fifty-seven consecutive STEMI cases undergoing invasive management were included. Radial access was the default route (6 cases via femoral access). Among radial cases, a TIG catheter was used first on 6 occasions (perceived low likelihood of subsequent PCI) and a Judkins right followed by an EBU catheter on three occasions (stock issue). A Q guide was used as initial default in the remaining 42 cases. Two anterior STEMI cases had recently undergone angiography and did not require right coronary reinspection. Procedural and outcomes data were recorded prospectively.

RESULTS

The Q catheter allowed complete assessment and treatment in 33 cases, 6 cases requiring a second catheter and one patient dying prior to right coronary imaging. Territories of infarction were: anterior (n = 18), inferior (n = 14), inferoposterior (n = 3), lateral (n = 1), inferolateral (n = 2), inferoposterolateral (n = 2). Sixty-three out of 65 lesions were treated successfully. Median catheterization laboratory door to balloon time was 18 minutes (IQR 15-21 minutes). There were no catheter-related complications.

CONCLUSIONS

A default Q guide catheter allows rapid effective imaging and treatment of both left and right coronaries in the majority of STEMI cases suitable for radial access PPCI.