Efficacy of the EBU Guide Catheter as a Bailout and Selective Strategy in Challenging Right Coronary Artery...

Right coronary artery (RCA) percutaneous coronary intervention (PCI) is often complicated by anatomical factors such as the RCA ostium's variable position within the aortic sinus, the orientation of the proximal RCA segment, aortic root diameter, and lesion complexity that can compromise guide catheter engagement and support. Although the Extra Back‑Up (EBU) catheter is typically used for left coronary interventions, it may have a selective role in RCA PCI, particularly in complex anatomies or as a bailout after failure of standard guides.

We performed a single-center, retrospective analysis of two cohorts of RCA PCI procedures. The EBU group included 60 RCA PCI procedures performed between 2019 and 2023 where the EBU catheter was used selectively for complex anatomy or after standard catheter failure. The control group comprised 200 consecutive RCA PCI procedues performed in 2023 using standard guide catheters. Primary outcome was catheter success. Secondary outcomes encompassed procedural efficiency and safety endpoints.

Catheter success rates did not differ significantly between EBU and standard groups (93.3% vs. 94.5%; p  =  0.729), despite a markedly higher prevalence of chronic total occlusions in the EBU cohort (48.3% vs. 15.0%; p  <  0.001). Overall complication rates including catheter-induced dissection, no-reflow, and general systemic events were low and comparable between cohorts. Operators reported particular EBU utility in low-sitting and upward-take-off RCA ostia.

The EBU catheter can be an effective bailout option for RCA PCI after failure of standard guides, demonstrating comparable procedural success and safety in selected appropriate scenarios. Nevertheless, its off-label use mandates a cautious approach.