![]() Based on our experience, right radial approach appears to be safer and quicker.Ĭopyright © 2015. We have successfully employed radial technique after failed trans-femoral attempts and also in STEMI situations. Many operators have been using radial approach for anomalous coronary interventions. It is also interesting to note that the radial access provides better guide support that is needed to tackle complex lesions. This goes to show how different treatment options can be employed in management of complications associated with anomalous coronary arteries. These cases were managed differently by conservative, surgical or interventional approaches. Whereas two of our patients presented with chronic symptoms, two presented as acute cases with electrocardiographically proven STEMI. Three of them had anterior course between aorta and pulmonary trunk, confirmed by coronary CT angiography (CTA). They had their origin in the left coronary sinus or off left anterior descending artery (LAD). This case series begins with a brief description of four separate cases of ARCA. Based on prior experience, management of asymptomatic ARCA with malignant course should be subjected to a risk-benefit analysis. Asymptomatic patients with malignant course of anomalous coronaries can pose clinical dilemmas. Sudden cardiac deaths are more common when the anomalous vessel runs an inter-arterial course between the aorta and the pulmonary artery. Although mostly asymptomatic and recognized incidentally on cardiac catheterizations, they can be catastrophic and can cause sudden cardiac 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.Īnomalous right coronary arteries (ARCA) are extremely rare in general population. 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. 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.Ī 58-year-old Japanese man was admitted to our hospital complaining of worsening exertional chest pain. ![]()
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