Coronary angiography can be performed from the femoral, brachial and radial arteries to access the left coronary artery.
Left coronary artery cannulation is preferred to percutaneous femoral artery puncture coronary artery cannulation (Judkins) left tube. The guidewire is inserted into the Judkins tube and fed anteriorly out of the tip of the catheter for 4-5 cm. After the catheter passes through the aortic arch into the ascending aorta, the guidewire is withdrawn, a triple tee and syringe are connected, and the catheter is filled with contrast medium.
Under fluoroscopy in the left anterior oblique position (or right anterior oblique position), the catheter is pushed forward so that the first bend of the catheter is along the posterior wall of the ascending aorta and the second bend is along the anterior wall of the aorta, and then it is sent to the root of the aorta, and the tip of the catheter enters into the mouth of the left coronary artery on its own if the size of the catheter is appropriate.
Alternatively, a transhumeral artery incision for coronary artery cannulation (Sones method) can be used. with the x-ray projection in the anterior-posterior position, the Sones tube is delivered into the left Valsalva sinus and gently pressed against the sinus wall. The catheter is rotated counterclockwise as it is passed forward, and when the tip stops oscillating and the anterior curvature suddenly straightens, the catheter has entered the left coronary orifice.
You can also choose the radial artery route, the 5F shared catheter to the root of the ascending aorta, withdraw the guidewire and connect the triple tee, pay attention to monitor the arterial pressure, the head of the catheter at this time mostly pointing to the right sinus, you need to slowly withdraw and clockwise rotation of the catheter, when the feeling of the anterior end of the slight upward rebound indicates that it has been to the opening of the left coronary, and inject a small amount of contrast medium, to be confirmed.