Case 190: Manual of PCI - Heavily calcified + tortuous anomalous circumflex

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A patient was referred for PCI of a heavily calcified right coronary artery and an anomalous circumflex arising from the proximal RCA after a failed attempt for wiring the circumflex. Wiring the circumflex was very challenging because of highly angulated origin. Use of a Sion black wire through a Sasuke microcatheter failed, as did the reversed guidewire technique. Using a Venture angulated microcatheter and a Sion black wire the anomalous circumflex was eventually wired but balloon delivery was extremely challenging: only a 1.0 mm Sapphire Pro balloon could cross. Other balloons and an intravascular lithotripsy catheter could not cross. Rotational atherectomy was performed in the circumflex through a Liquid guide extension so as not to remove the RCA wire. Stents could still not be delivered into the circumflex because of the tortuosity and calcification. Eventually the anomalous circumflex was treated with a 2.5x30 mm Agent DCB, followed by stenting of the RCA with Orsiro stents with an excellent final result.
Category
Cardiology
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