MCQ 36: PCI through radial route

Q. Advantages of choosing left radial artery over right radial artery during trans-radial PCI are all except?
A. Prevalence of subclavian artery tortuosity and radial artery loops are three times more common in right radial artery
B. Hooking of LIMA is easier from left radial artery
C. Learning curve is short in left radial route than right
D. Incidence of radial artery spasms is more in right radial artery

Answer: D. Incidence of radial artery spasms is more in right radial artery

Explanation:

PCI from left radial route has many advantages as compared to right artery. Prevalence of radial artery loops and subclavian artery tortuosity are more three times more common on right side. Learning curve is longer in right radial artery and hooking of left internal mammary artery (after CABG) is difficult from the right radial route because it involves crossing to the opposite side from the aortic arch. However, the incidence of radial artery spasms during the procedure is same in both the sides (~3.5%).

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ECG Spotter

What is the diagnosis? Click the button below to view answer: Show Answer

High heart rate

The patient contacts the doctor over phone with this report. Obviously anxious because of his high heart rate (199 beats per minute) as detected by ECG machine. Should he be worried about this and come to emergency department as soon as possible? Correct answer- ECG machine has calculated his heart rate incorrectly. Heart rate is around 100 beats per minute. Other findings in this ECG include ST segment elevation in anterior chest leads along with presence of Q waves, denoting old MI changes with possibly development of LV aneurysm. In such cases, ST segment elevation can persist for long periods. Now, should he come to emergency department? Not because of detection of high heart rate. But, if he is having symptoms such as shortness of breath or chest pain, he should visit emergency department. Otherwise, if he is asymptomatic, he can schedule a regular visit with his cardiologist.

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