Clinical Images

Single Sheath for Dual Injection Prior to CTO Intervention

Eleftherios Kontopodis, MD;  Nikolaos Oikonomidis, MD;  Ioannis Tsiafoutis, MD;  Efstathios Lazaris, MD;  Michael Koutouzis, MD, PhD

Eleftherios Kontopodis, MD;  Nikolaos Oikonomidis, MD;  Ioannis Tsiafoutis, MD;  Efstathios Lazaris, MD;  Michael Koutouzis, MD, PhD

J INVASIVE CARDIOL 2019;31(12):E394.

Key words: cardiac imaging, coronary angiography, new technique


A 78-year-old male smoker with known hyperlipidemia was referred for coronary angiography due to stable angina.

We performed coronary angiography using the right radial approach through a 6 Fr, 11 cm-long sheath that showed triple-vessel coronary artery disease with a chronic total occlusion at the proximal part of the left anterior descending (LAD) coronary artery. In order to plan our revascularization strategy and evaluate the LAD chronic total occlusion in more detail without a second arterial puncture, we decided to perform a “single-access dual injection.”   

We exchanged the 6 Fr sheath  with an 8 Fr, 11 cm-long sheath and two 4 Fr diagnostic catheters (JL3.5 and JR4) were inserted through the single radial  sheath (Figures 1C-1E). We engaged both coronary ostia and dual injection was successfully performed (Figure 1F) with good image quality and adequate lesion evaluation. 

To our knowledge, this is the first reported case of a dual injection using a single-sheath approach in order to evaluate a chronic total occlusion and plan a future intervention.


From the Second Department of Cardiology, Hellenic Red Cross Hospital of Athens, Greece.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein. 

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted March 5, 2019.

Address for correspondence: Eleftherios Kontopodis, MD, 2nd Department of Cardiology, Hellenic Red Cross Hospital, Athanasaki 1, GR 11526, Athens, Greece. Email: ekontopodis@gmail.com

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