Case 197: Manual of PCI - Airmail

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A patient presented with unstable angina and was found to have 90% severe in-stent restenotic lesion in a previously placed ramus stent and an 80% also in-stent aorto-ostial lesion of the right coronary artery. Engagement of the RCA was challenging with significant pressure dampening. The “airmail” technique was used to wire the RCA: the guide catheter was placed into the aorta facing towards the RCA ostium, followed by guidewire advancement that eventually entered the RCA. Using the distal anchor and inchworming technique a 6 French guide extension was advanced to the proximal RCA and a stent was deployed with a nice result and ostial coverage as confirmed by IVUS. The ramus lesion could not be crossed with a workhorse wire but was successfully crossed with a Sion black polymer-jacketed wire. After balloon angioplasty a nice result was achieved.
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Cardiology
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