Use of the RCB guide in PCI of a chronic total occlusion in an anomalous right coronary artery with high anterior takeoff

Abstract

An anomalous right coronary artery (RCA) with a high anterior takeoff is an uncommon and technically challenging vessel to cannulate and to intervene upon. We describe here an unusual case of chronic total occlusion in a patient with an anomalous dominant RCA accompanied by a high anterior takeoff, in whom there was insufficient catheter seating despite the exchange of several different guiding catheters during percutaneous intervention. This illustrative case demonstrates that if routine guiding catheters fail, early consideration can be made to use a right coronary bypass guiding catheter positioned with clockwise torque to obtain a stable platform for intervening on complex lesions in an anomalous RCA with a high anterior takeoff. This technique resulted in a successful procedure when many other guiding catheters had failed; it provided satisfactory backup support for the passage of stent and balloon catheters and reduced the procedural time and radiation exposure, as well as the amount of radiocontrast agent used.