Successful coronary stenting in anomalous right coronary artery by using an inner catheter with mother and child techniq
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CASE REPORT
Successful coronary stenting in anomalous right coronary artery by using an inner catheter with mother and child technique under multislice CT guidance Kazuhiko Yumoto • Hajime Aoki • Yasuhiro Shirai Yasutoshi Shinoda • Kenichi Kato
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Received: 13 April 2012 / Accepted: 2 August 2012 / Published online: 28 August 2012 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2012
Abstract The ectopic location and unusual coronary course of the anomalous right coronary artery (RCA) from the left sinus of Valsalva makes percutaneous coronary intervention difficult. In this report, we describe a case of successful stent implantation in an anomalous RCA performed using a 4.5F inner catheter with a 6F guiding catheter used in the mother and child system under the guidance of multislice computed tomography. This approach was found to be safe and feasible in cases involving anomalous coronary origin because of the excellent engagement and support provided by the guiding catheter.
balloon and stent. Although proper catheters have been selected, selective cannulation and maintenance of the coaxial position might be technically difficult. Critical complications, including dissection of ostial RCA and sinus of Valsalva, may occur as a result of the use of large curved guiding catheters [4, 5]. A 4F inner catheter has recently been developed [6], and the mother and child technique of 4-in-6 provides superior trackability to access the coronary artery and deliver the coronary stent in various situations [6–8].
Case report Keywords Coronary anomalies Mother and child technique Percutaneous coronary intervention
Introduction Coronary arteries of anomalous origin are uncommon. The right coronary artery (RCA) arising from the left sinus of Valsalva is only reported in 0.1–0.9 % of patients undergoing diagnostic coronary arteriography [1–3]. An anomalous RCA from the left sinus of Valsalva creates a sharp angle from the ectopic ostium and courses between the aorta and the pulmonary artery [2]. Therefore, for percutaneous coronary intervention (PCI) in anomalous coronary arteries, cannulation of the guiding catheter is important in providing adequate support. Proper cannulation also aids in manipulation of the guidewire and smooth delivery of the K. Yumoto (&) H. Aoki Y. Shirai Y. Shinoda K. Kato Department of Cardiology, Yokohama Rosai Hospital, 3211 Kozukue-cho, Kohoku-ku, Yokohama 222-0036, Japan e-mail: [email protected]
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A 65-year-old man with a history of hypertension and diabetes was admitted with chest pain. His electrocardiogram revealed ST segment elevation in leads II, III, and aVf, with complete atrioventricular (AV) block. His heart rate was 40 beats/min, which indicated acute inferior myocardial infarction. He was given 320 mg of oral aspirin and an intravenous injection of 5000 units of heparin in the emergency room, and an additional 5000 units at the catheter laboratory. An emergency direct coronary angiography via the right femoral artery was performed after inse
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