Transradial Approach Superior to Transfemoral Approach for Guide Catheter Engagement of Right Coronary Artery

Introduction Percutaneous coronary intervention (PCI) has become the treatment of choice for patients with symptomatic one-vessel coronary artery disease especially when they fail medical therapy alone. Guide catheter support is essential to perform PCI. Transfemoral access is the most commonly used access for PCI. Most guide catheter shapes are designed to allow co-axial engagement from the femoral approach. We have observed that transradial approach frequently provides superior guide support in patients where transfemorally placed guides are either suboptimal or on occasion not successful in engaging the target vessel. We describe a case of PCI of right coronary artery arising from right sinus of valsalva, where engaging the ostium from right femoral access was unsuccessful despite aggressive attempts, with subsequent transradial approach successfully allowing guide-catheter placement with extreme ease, followed by successful completion of ostial right coronary artery stenting.