2019 Volume 83 Issue 8 Pages 1763-
Although the attachment site of a guiding catheter (GC) in the contralateral side of the aortic wall is important for back-up force,1 it is not clear how a deep-seated GC is positioned in the aorta. Computed tomography obtained during percutaneous coronary intervention (PCI)2 showed how deep-seated GC were attached to the aortic wall.
An 85-year-old man with severe stenosis in the right coronary artery (RCA) underwent PCI. A 6-Fr JR4.0 was engaged to the RCA via the left radial artery (Figure A). To achieve good back-up support, the GC was deep-seated (Figure B). CT showed that the GC was twisted in a spiral (Figure C–E; Supplementary Movie 1).
(A,B,F,G) Fluoroscopy and (C–E,H–J) 3-D computed tomography during percutaneous coronary intervention superimposed on (C–E,H–J) preoperative imaging. (A) Normally positioned and (B) deep-seated JR4.0; (F) EBU4.5 engaged in the left coronary artery with rotation manipulation; (G) deep-seated EBU4.5. AP, anteroposterior oblique; CRA, cranial oblique; LAO, left anterior oblique; RAO, right anterior oblique.
A 66-year-old man with calcified stenosis in the left coronary artery (LCA) underwent PCI. A 6-Fr EBU4.5 was advanced from the left radial artery. The GC was deep-seated in the LCA (Figure F,G). CT showed that the GC was also twisted (Figure H–J; Supplementary Movie 2).
This imaging shows that a deep-seated GC is twisted in the aorta and that long segments are attached to the aortic wall.
The authors declare no conflicts of interest.
Supplementary Movie 1. Deep-seated JR4.0.
Supplementary Movie 2. Deep-seated EBU4.5.
Please find supplementary file(s);
http://dx.doi.org/10.1253/circj.CJ-18-1338
