A 35 year-old man was admitted for anterior myocardial infarction. He underwent thrombolytic therapy before admission.

Right coronary angiogram showed normal RCA without significant collateral flow to the left coronary artery.(Figure 1) Left coronary artery was engaged with a 7 Fr Judkins left catheter (Heartrail, TERUMO corp). Left coronary angiogram showed total occlusion at the proximal LAD.(Figure 2) After wire introducing, we tried thrombus aspiration with a Export Catheter.(Figure 3) Then, the tubular narrowing at the proximal LAD was seen.(Figure 4) The lesion was treated with a 3.5x18mm Cypher stent implantation.(Figure 5) Final angiogram showed a very good result with TIMI 3 flow.(Figure 6)

We experienced that the Heartrail guiding catheter permitted smoother manipulation and good backup support.