In our institution, we use standard JL and JR catheters for diagnostic transradial angiography. Are there any specific maneuvers for coronary artery cannulation with these catheters?
For the right, I generally find that the JR4 works best. I will bring the catheter to the valve and as I put clockwise torque on catheter, I slowly pull back. The trick is not to over torque the catheter. If the JR4 is not working, the next catheter I try is an ARmod 1. This works very well for high anterior take-offs. For the left system, the workhorse is the JL3.5 catheter. With the .035 wire in the catheter, I advance down into the sinus towards the valve and then, while pulling back on the .035 wire, I clock and lift the JL3.5. If the arch is elongated, as in elderly, hypertensive patients, you may need to use a JL4. At times, having the patient take in a breath will lift the catheter and help canulation of the coronary.
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