Dual Looping and Unlooping Wire Technique for Coronary Artery Aneurysm Angioplasty

We present a case in which a coronary aneurysm distorted the architecture of the left anterior descending coronary artery (LAD), causing extreme difficulties in wiring followed by uncrossable balloon catheters. We demonstrated how we completed the angioplasty using dual 360° looping guidewires followed by unlooping of the guidewires.

LAD wiring was performed with a 360° looping guidewire technique. The LAD was wired again with a buddy wire in the same looping fashion. The LAD guidewire was unlooped using the 2 guidewires and a balloon catheter.

Risks for guidewire-induced dissection or rupture of the aneurysm wall exist. They can be mitigated by using polymer-jacketed guidewires with low-gram tip load and perhaps a microcatheter to offer extra safety.

In extreme coronary anatomy involving aneurysm, the looping wire technique can be helpful in wire crossing. To unloop a looped guidewire, the principle is to increase the distal resistance in the parent vessel.