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What role should EBU catheters play in the interventional approach to anomalous right coronary arteries? A case
Mikias Legesse Gebremedhin1, Milan Sigdel2, Zhao Ruixue1
1Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Insights
The Extra Back-Up (EBU) catheter shows promise for percutaneous coronary intervention (PCI) in anomalous right coronary artery (ARCA) cases, particularly Types A and B. This study suggests EBU is a viable option for challenging ARCA anatomies.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Anatomy
Background:
- Percutaneous coronary intervention (PCI) for anomalous right coronary artery (ARCA) presents significant technical challenges due to variable ostial anatomy.
- The Extra Back-Up (EBU) catheter, typically used for left coronary interventions, has potential benefits for ARCA PCI, but its efficacy across different anatomical subtypes is not well-established.
Purpose of the Study:
- To evaluate the procedural success and safety of the EBU catheter in patients undergoing PCI for anomalous right coronary artery (ARCA).
- To assess the performance of the EBU catheter across various ARCA anatomical subtypes, including Type A, Type B, Type C, and high take-off anatomies.
Main Methods:
- A retrospective case series of 17 patients with ARCA who underwent procedures using an EBU catheter between 2019 and 2024.
- Patients were categorized by ARCA anatomy: Type A (ostium above LCA), Type B (below LCA), Type C (midline), or high take-off (≥10 mm above sinotubular junction).
- Primary outcomes included procedural success (defined as stable engagement, full device delivery, no catheter exchange) and safety.
Main Results:
- The EBU catheter achieved 100% procedural success in Type A ARCA and 83.3% in Type B ARCA when used as the initial guide.
- Success rates were lower in Type C and high take-off anatomies, with one success in two cases each.
- The EBU catheter was also used successfully as a rescue device in five patients after failure with standard catheters; no catheter-related dissections occurred.
Conclusions:
- The EBU catheter demonstrated successful application as both a primary and rescue tool in a majority of selected ARCA cases.
- Highest success rates were observed in Type A and Type B ARCA anatomies.
- The EBU catheter appears to be a valuable option for operators managing complex ARCA PCI, warranting further prospective investigation.
Background:
Percutaneous coronary intervention (PCI) for anomalous right coronary artery (ARCA) remains technically challenging due to variable ostial anatomy. The Extra Back-Up (EBU) catheter, although designed for left coronary interventions, may offer advantages in ARCA PCI, but its performance across anatomical subtypes is not well defined.
Methods:
This single-center retrospective case series included 17 patients (2019-2024) with ARCA from the left coronary sinus or with high take-off anatomy, in whom an EBU catheter was used. Fourteen patients underwent PCI, one had fractional flow reserve (FFR)-only assessment, and two underwent diagnostic angiography alone. Anatomical subtypes were: Type A (ostium above left coronary artery [LCA]), Type B (below LCA), Type C (midline), or high take-off (≥10 mm above sinotubular junction). Primary outcomes were procedural success (stable engagement, full device delivery, no catheter exchange) and safety.
Results:
Procedural success with the EBU catheter was 100% in Type A (2/2) and 83.3% in Type B (5/6) when used as the initial guide. In Type C and high take-off anatomies, success was achieved in one of two cases each. EBU was also employed as a second-choice catheter in five patients(one Type A, three Type B, one high take-off) after failed engagement with standard guides catheters. No catheter-related dissections occurred. One minor in-hospital complication (5.9%) and one patient required unplanned re-intervention within 30 days.
Conclusions:
In this descriptive series, the EBU catheter was successfully employed as a primary or rescue tool in a majority of select ARCA cases, with the highest success in Types A and B. These observations, while not comparative, suggest it is a viable option in the operator's arsenal for these challenging anatomies and warrant further prospective evaluation.
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