#Guideliner free#

In the emergency room of our hospital, his blood pressure was 146/88mmHg, and pulse was 64 beats/minute and regular.

#Guideliner free#

He subsequently remained free from chest symptoms for almost 2 years postoperatively. Blood flow from the GEA graft and native RCA supplied the proximal lesion of the PD artery. Routine coronary angiography after surgery demonstrated complete graft patency and unexpected spontaneous reperfusion in the culprit lesion of ACS. The left internal thoracic artery (LITA) was sequentially grafted from the high lateral branch to the LCX posterolateral branch, and the gastroepiploic artery (GEA) was grafted to the right postero-descending (PD) artery. He then underwent coronary artery bypass grafting (CABG). Coronary computed tomography angiography (CTA ) demonstrated that the RCA coursed anteriorly between the aorta and pulmonary artery, the so-called ‘interarterial course’, and then in the atrioventricular (AV) groove to continue its normal distribution. However, because the RCA originated from the left sinus of Valsalva, RCA cannulation with a guiding catheter was difficult, and RCA reperfusion in the acute phase could not be achieved. The culprit lesion of ACS was considered to be the RCA. At that time, emergent cardiac catheterization demonstrated an occlusive lesion in the mid portion of his RCA and severe stenosis of both the high lateral branch and left circumflex (LCX) artery. He had developed acute coronary syndrome (ACS) 2 years previously. The GuideLiner catheter (Vascular Solutions Inc., MN, USA), a device which became available in Japan in 2014, is effective for completing PCI even with such an anomalous RCA by coaxially enhancing back-up support for the guiding catheter.Ī 58-year-old Japanese man was admitted to our hospital complaining of worsening exertional chest pain. Because of the unusual anatomy, such as the anomalous position of the RCA ostium within the left aortic sinus, a slit-like orifice or atypical angulation, seen in this type of anomalous RCA, selective cannulation of the guiding catheter in percutaneous coronary intervention (PCI) for these cases is always challenging. It has been reported that this type of anomaly is observed in approximately 10% of the population with an anomalous coronary artery. An anomalous origin of the right coronary artery (RCA) from the left sinus of Valsalva is uncommon but occasionally noted in association with potentially serious sequelae such as sudden death. GuideLiner is a monorail-type “child” support catheter that facilitates coaxial guiding catheter engagement and an appropriate back-up force, achieving successful device delivery to target lesions in this kind of complex percutaneous coronary intervention.Īnomalies of the coronary artery are a diverse group of congenital disorders that have been investigated by many authors. Final angiography demonstrated favorable dilatation of the target lesion, and native blood flow in the right coronary artery was completely recovered. And we successfully deployed two drug-eluting stents by crossing over the posterior-descending artery. A 6Fr GuideLiner catheter was introduced into the right coronary artery by anchoring it coaxially with a semi-compliant balloon catheter. Therefore, we decided to use the GuideLiner catheter for stable back-up support from the beginning. On the previous percutaneous coronary intervention, we failed to cannulate the guiding catheter to the anomalous orifice of the right coronary artery. We found a subtotal occlusive lesion in the mid-portion of his right coronary artery that originated from the left sinus of Valsalva. He was suspected of having unstable angina pectoris and underwent cardiac catheterization.

Case presentationĪ 58-year-old Japanese man was admitted to our hospital complaining of worsening exertional chest pain. Because of the unusual anatomy of an anomalous origin of the right coronary artery from the left sinus of Valsalva, selective cannulation of the guiding catheter in percutaneous coronary intervention for these cases is always challenging.