Steam-deformed Judkins-left guiding catheter with use of the GuideLiner^® catheter to deliver stents for anomalous right coronary artery

Abstract

Objective:Percutaneous coronary intervention for anomalous right coronary artery (RCA) originating from the left coronary cusp is challenging because of our current inability to coaxially engage the guiding catheter.Methods:We report a case of an 88-year-old woman with non-ST segment elevation myocardial infarction, with an anomalous RCA origin. Using either the Judkins-Left catheter or Amplatz-Left catheter was difficult because of RCA ostium tortuosity. Thus, we used steam to deform the Judkins-Left catheter, but back-up support was insufficient to deliver the stent.Results:We used GuideLiner®, a novel pediatric catheter with rapid exchange/monorail systems, to enhance back-up support.Conclusions:We were able to successfully stent with both the deformed Judkins-Left guiding catheter and GuideLiner® for an anomalous RCA origin.

Balloon-Anchored CoKatte® for Successfully Delivering Balloons for an Occluded Anomalous Right Coronary Artery

“…There was no appropriate side branch for balloon-anchoring to obtain backup force. Therefore, we used a child catheter, which has been reported to facilitate PCI of an anomalous RCA, 5 but it did not work independently. To strengthen the backup force, manipulation of a guidewire during balloon inflation and fixation of a child catheter with an inflated balloon were needed.…”

“…In another report, use of the steam-deformed Judkins left guiding catheter with the GuideLiner ® catheter (Japan Lifeline, Tokyo, Japan) was promising to deliver stents for anomalous RCA, as it overcame the problem of incorrect coaxiality. 5 In the case of PCI for a chronic occluded coronary artery, stronger backup support is needed, because the lesion solidity obstructs balloons. The CoKatte ® (Asahi Intecc, Nagoya, Japan) is a novel, straight 4.5-French (F) child catheter that produces coaxial guiding catheter extension.…”