Case 56: PCI Manual - Coronary anatomy assessment: core principles

This is a case of a patient who presented with unstable angina and was found to have a high grade lesion in the RCA that appeared to be the culprit. However, the patient also had a long left main and no coronary artery was seen supplying the lateral wall. Non-selective contrast injection in the right sinus of Valsalva showed an anomalous circumflex arising below the ostium of the right coronary artery with a significant ostial lesion. PCI of the shepher's crook RCA was successfully performed using an AL1 guide catheter that provided strong support. The anomalous circumflex was engaged with a multipurpose guide and nitroglycerin was administered. There was no lesion in the circumflex ostium, suggesting that the initially seen "lesion" was actually spasm.
This case illustrates 2 core principles for assessing coronary anatomy: (1) coronary flow to all myocardial territories needs to be identified, which is especially important in patients with prior CABG; and (2) nitroglycerin should be routinely administered before coronary angiography (unless the patient has a contraindication, such as severe hypotension) to help exclude spasm.
Finally, use of AL guide catheters can facilitate PCI of RCA lesions when using radial access by providing strong support.

[@dokowisjytra6759]

Realy great case.

[@salahuddinsalahuddin3210]

Thanks for the nice case presentation.

[@guozhuchen5511]

Thank you very much!

[@nguyenkhanh5956]

useful case. Thanks sir!

[@BarrieLouis]

Interesting

[@aq4019]

Good evening sir, did you attend EuroPCR this year?