Telescoping catheter technique: looking towards the kidneys

Patients with chronic kidney disease (CKD) undergoing PCI are at very high risk from the development of contrast-induced nephropathy (CIN). Development of CIN in patients with CKD is an independent predictor of in-hospital and 1-year mortality, and contrast load is an important predictor for CIN development. The Terumo 'five-in-six' system involves insertion of an extra-length, 5F Terumo guide catheter (Heartrail, Terumo) into a standard 6F guide catheter so that the tip protrudes beyond the 6F guide. We describe the use of this system to facilitate extra-deep selective coronary intubation and opacification of native coronary vessels in order to minimize contrast use in patients with severe renal dysfunction, thereby reducing the potential for CIN development. This technique should be considered in patients at high risk from developing renal complications post PCI.