Successful Cypher Stent Implantation With Deep Seating of 6 French Guiding Catheter in Very Tortuous Right Coronary Artery
- Operator : Seung-Jung Park
|Successful Cypher Stent Implantation With Deep Seating of 6 French Guiding Catheter in Very Tortuous Right Coronary Artery|
|- Operator: Seung-Jung Park, MD|
|A 60 year-old man was admitted with stable angina 6 months ago. A Taxus stent (3.5 x 20 mm) and a Driver stent (3.0 x 15 mm) were implanted without overlapping at the right coronary artery (RCA) lesion. His coronary risk factors were hyperlipidemia and hypertension. Baseline ECG was normal and echocardiography showed normal LV ejection fraction of 56% and concentric LVH.|
|Follow-up angiogram at 6 months showed tight stenosis at the gap between the two implanted stents (Figure 1). Because the RCA looked very tortuous, calcific, and rigid, we initially engaged the lesion with a 7 Fr left Amplatz guiding catheter for a good back-up support. However, coaxial alignment was not good (Figure 2). Thus, we changed the guiding catheter with a Hockey stick (Figure 3). After advancement of a Neos guidewire, predilation was performed with a Black Hawk balloon (3.0 x 20mm) (Figure 4, Figure 5). Although we tried to insert a Cypher stent (3.5 x 23mm) to the target lesion, the stent could not pass the tortuous RCA. Therefore, we intended to engage the RCA with the technique of deep coronary intubation with a 6 Fr Judkins right guiding catheter with a 3.5cm curve (Figure 6). After deep seating of a 6 Fr guiding catheter in the middle RCA, we successfully delivered a Cypher stent (3.5 x 23mm) and deployed it in the target lesion (Figure 7). Final angiograms showed a successful result (Figure 8, Figure 9).|
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