“Mother Infant” technique. 4 French pigtail inside a 6 French XBLAD 3.0 to prevent “razor effect” in a patient with NSTEMI

Background Larger French and more acutely shaped guide catheters when encountering hostile radial artery anatomy such as: loops; tortuosity; arterial spasm; and smaller caliber arteries can create problems when passing catheters. In particular, the sharp edge of the guide catheter tip can produce a “razor effect” while traversing over the wire that can prevent the guide catheter advancement. Case summary We present a 39-year-old male presenting with angina requiring cardiac catheterization and PCI. Upon advancing an XBLAD 3.0 guiding catheter, it was noticed that it would not advance several centimeters distal to the elbow. The patient complained of forearm pain. Under fluoroscopy a clear “razor effect” was happening. Discussion We describe a “Mother Infant” technique, a 4 French pig inside the 6 French XBLAD 3.0 passed with ease into the ascending aorta without the patient complaining of discomfort that assuaged the problem of razor effect. PCI was completed uneventfully and the guide catheter was removed with the pigtail inside to avoid any possibility of dissection or shearing of the radial artery. Take home message The use of a “Mother Infant” technique can prove useful when a “Mother Child” technique fails or the need for increased steerability of catheters is necessary to keep catheters off of radial artery intima's where razor effect is prevalent.