Efficacy of Novel Techniques Using a 4-F, 130-cm JR4.0 Catheter for Challenging Guiding Catheter Engagement

Percutaneous coronary intervention is a mature procedure with a high success rate. However, there are rare situations in which a guiding catheter cannot engage the coronary artery ostium, such as with an anomalous aortic origin of a coronary artery or interference from a transcatheter aortic valve implantation. This report presents 4 cases in which novel techniques using a 4-F, 130-cm JR4.0 catheter were successfully applied. This technique is especially valuable in patients with anomalous coronary artery origins or after transcatheter aortic valve implantation. Its use may improve procedural success, reduce contrast volume, and enhance wire control without the need for custom-shaped guiding catheters.