The use of multiple "buddies" during transradial angioplasty in a complex calcified coronary tree

Area of Science:

• Interventional Cardiology
• Vascular Surgery

Background:

• Transradial coronary angioplasty is a minimally invasive approach for treating coronary artery disease.
• Complex coronary anatomy, including tortuosity and calcification, presents significant challenges for percutaneous coronary intervention.
• Surgical revascularization is not always a viable option for all patients with severe coronary artery disease.

Observation:

• A patient with a tortuous, calcified coronary tree, deemed unsuitable for surgical revascularization, underwent transradial coronary angioplasty.
• The complex anatomy necessitated plaque modification strategies for successful intervention.

Findings:

• Rotational atherectomy was employed in the left anterior descending coronary artery to address plaque burden.
• A novel technique utilizing an inflated "buddy balloon" in the circumflex artery facilitated successful stent deployment.
• This buddy balloon technique proved effective in navigating calcified and tortuous segments.

Implications:

• The findings suggest that transradial coronary angioplasty can be successfully performed even in highly complex coronary anatomies.
• The "buddy balloon" technique offers a simple, inexpensive, and potentially valuable approach for advancing stents in challenging coronary lesions.
• This case highlights the feasibility of percutaneous coronary intervention as an alternative to surgical revascularization in select complex cases.