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Bailout Access to an Anomalous-Origin Occluded Right Coronary Artery Using Anchor Wire Stabilization in Cardiogenic
Hung M Ngo1, Luan T Mai2, Bao T Truong2
1Department of Interventional Cardiology, Cho Ray Hospital, Ho Chi Minh City, Vietnam; Faculty of Medicine, Nam Can Tho University, Ho Chi Minh City, Vietnam.
Insights
A novel anchor wire technique provides a safe bailout strategy for accessing anomalous right coronary artery (RCA) occlusions causing ST-segment elevation myocardial infarction (STEMI) and cardiogenic shock in unstable patients.
Area of Science:
- Interventional Cardiology
- Vascular Access Techniques
- Acute Coronary Syndromes
Background:
- Anomalous origin of the right coronary artery (RCA) can lead to challenging aorto-ostial occlusions.
- These occlusions, particularly with ST-segment elevation myocardial infarction (STEMI) and cardiogenic shock, require specialized access techniques.
- Standard approaches may be insufficient or carry significant risks in these complex anatomical variations.
Objective:
To present a reproducible bailout technique using anchor wire stabilization in the left anterior descending artery for accessing aorto-ostial right coronary artery (RCA) occlusion with anomalous origin in inferior-right ventricular ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock.
Key Steps:
1) Anchor a 6-F Amplatz left 1.0 guiding catheter in the left coronary system with a Sion guidewire for stability. 2) Perform controlled clockwise rotation and probing of the aortic root using a Runthrough guidewire to cross the occluded anomalous RCA ostium. 3) Perform balloon angioplasty followed by stent implantation to achieve TIMI flow grade 3 and hemodynamic stabilization.
Potential Pitfalls:
The Amplatz left catheter and/or stiffer wires could jeopardize the aortic root and coronary ostium. Early aortography is recommended if the RCA appears "absent" on nonselective injections to detect ostial occlusion and/or anomalies.
Take-Home Messages:
Acute aorto-ostial occlusion of an anomalous RCA may cause inferior-right ventricular STEMI and apparent angiographic "absence". This anchor-assisted probing maneuver offers a safe, effective bailout strategy for difficult coronary access in unstable patients.
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