Chapter 27: Left Internal Mammary Artery Angiography via the Transradial Approach with the Bartorelli-Cozzi Catheter

History of the Bartorelli-Cozzi catheter

In 1997, the cardiac surgeons at the Centro Cardiologico Monzino in Milan started a new program of isolated LIMA-to-LAD grafting by minimally invasive technique following the early experience of other surgical Italian groups. Because they were in the initial learning phase of minimally invasive direct coronary bypass grafting (MIDCABG), early angiography was recommended to exclude stenosis at the anastomotic site and lesions of the LAD due to vascular snare devices that were used to provide vessel occlusion and a bloodless operative field. Thus, they asked us to perform routine angiographic evaluation of the arterial anastomosis before discharging the patients. A transradial approach was preferred because selective LIMA angiography via the femoral artery usually required prolonged bed rest to obtain stable hemostasis and to avoid vascular complications. The related increase in hospital stay and costs would have reduced the cost-effectiveness of MIDCABG. However, use of this vascular access was limited by the design of available conventional diagnostic catheters that were intended for transfemoral use. The curve style rarely allowed easy and coaxial positioning and optimal visualization of the LIMA when advanced retrograde via the left radial artery. Thus, in conjunction with Cordis Europe (LJ Roden, the Netherlands) we developed a modified LIMA catheter for allowing easy, quick, and safe cannulation of the LIMA through the ipsilateral radial approach. The catheter quickly became available for clinical use.

Antonio L. Bartorelli, MD, FACC, FESC; Cristina Ferrari, MD; Sergio Cozzi, MD