Objective To explore the management of left coronary artery cannulation difficulty because of right subclavian artery and/or brachiocephalic trunk tortuosity when coronary angiography via right radial artery. Methods Right subclavian artery and/or brachiocephalic trunk tortuosity when coronary angiography via right radial artery often result in left coronary artery cannulation difficulty. To finish the selective left coronary angiography, unarmed styling of the proximal catheter, between the first and second turn, was carried out to make it more flexibility. Results The procedure was clinically successful in all 35 patients. The success rate was 100% , and no complications occurred. The 28 patients were diagnosed coronary artery diseases by coronary angiography. Conclusions Unarmed styling of the proximal catheter is an effective, easy, safe and economical method when left coronary artery cannulation difficulty occurred because of right subclavian artery and/or brachiocephalic trunk tortuosity when coronary angiography via right radial artery.%目的 探讨经右桡动脉冠状动脉造影时右锁骨下动脉和(或)头臂干迂曲致选择左冠状动脉口困难的处理方法.方法 经右桡动脉行冠状动脉造影时,由于右锁骨下动脉和(或)头臂干迂曲,致共用导管选择左冠状动脉口困难,此时将共用导管前端即第一、二弯之间及第二弯近段徒手塑形,使其弯曲度增大,观察用此方法行选择性左冠状动脉造影的结果及安全性.结果 35例选择左冠状动脉口困难的患者均造影成功,成功率100％,无相关并发症发生.28例患者经造影确诊冠心病.结论 经右桡动脉冠状动脉造影时右锁骨下动脉和(或)头臂干迂曲致选择左冠状动脉口困难时,行导管前端塑形是一种有效、简便、安全且经济的方法.
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