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Figure 4 Trans(coronary) venous cell delivery. (A) The coronary sinus (CS) is engaged, and a J-tipped hydrophilic guide wire is placed into the anterior interventricular coronary vein (AIV). (B) The CS and SS guiding catheters are placed using conventional over-the-wire wire technique. (C) The hydrophilic wire is exchanged for a 0.014-inch guidewire, and the TransAccess catheter is advanced into position. (D,E) IVUS provides anatomic orientation for transvenous, myocardial puncture into the anterior (D) and septal (E) (IVUS pointer marker delineated by yellow arrows) walls from the AIV with (F) an extendable nitinol needle (arrows). The IntraLume microinfusion catheter is advanced to targeted areas for cell delivery (G, arrows delineate contrast-enhanced cell injections). This method allows contiguous "beads" of cell substrate to be placed. AIV = anterior interventricular coronary vein; CS = coronary sinus; GW = guide wire; IVUS = intravascular ultrasound; LAD = left anterior descending coronary artery; SS = subselective; TA = TransAccess catheter.
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