Clinical Case Reports

Biography

Biography: Gianfranco Aprigliano

Abstract

We present a case of right coronary artery obstruction with tortuous course increasing the difficult in angioplasty and stenting. Sometimes it is easy to pre-dilate the lesion with balloons but distal stent placement may prove difficult or impossible. This kind of procedure may lead to harmful complication. We describe the use of a rapid-exchange style guide catheter extension to facilitate distal stent implantation and post-dilatation. A 60-year-old male, current smoker affected by dyslipidemia and hypertension presented to our emergency department for effort angina occurred in the last three days. Ultra-sensitive Troponin test, resting ECG and Echocardiogram were normal. Since the high pre-test probability a CT coronary angiography scan was performed revealing a critical right coronary artery stenosis. The patient was admitted to our cardiology department and the day after underwent to coronary angiography via right radial artery that confirmed the diagnosis. In particular the vessel was extremely tortuous and diseased in the proximal part and distally in the postero-lateral branch. Despite the use of high support Amplatz Left 2 guide catheter from Cordis it was impossible to reach the target distal lesion. We successfully employed a guide extension catheter GUIDEZILLA from Boston advancing it deeply in the coronary using the “anchoring balloon technique”. The procedure easily allowed a two drug eluting stent implantation with nice final result. The same device was finally used to optimize post dilatation with non-compliant balloons at high pressure. Similar technique was already used in the past with the insertion of a smaller guide catheter (“child in mother” telescopic technique) but was more complex in managing the procedure steps. All the passages are well documented by movies. The patient was discharged two days later without complication. At 6-months follow up he remained asymptomatic without complaint