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Management of STEMI in an Ectatic and Tortuous Right Coronary Artery Using a Flexible Guide Catheter Extension: A
Yasuyuki Toyama1, Shinya Okabe1, Tetsuya Hashimoto1
1Department of Cardiovascular Medicine, Iseikai International General Hospital, Osaka, Japan.
Background And Aims:
Coronary artery ectasia poses unique challenges during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (STEMI), owing to thrombus burden and vascular tortuosity. This case demonstrates successful reperfusion using a flexible, hydrophilic-coated guide catheter extension (GuidePlus, Nipro, Osaka, Japan).
Methods:
A 45-year-old man with inferior STEMI had complete occlusion of a severely ectatic (6.5 mm, 1.8× reference) and tortuous RCA with a 'shepherd's crook' morphology. The conventional GuideLiner failed to cross. GuidePlus, a soft and hydrophilic extension, enabled thrombus aspiration and intracoronary urokinase (240,000 IU) delivery. A 4.0 × 28-mm drug-eluting stent (Ultimaster, Terumo) was deployed and postdilated (5.0-mm NC balloon).
Results:
The GuidePlus enabled smooth navigation, direct aspiration and thrombolysis. Final angiography confirmed TIMI Grade 3 flow with minimal residual thrombus. The patient was discharged uneventfully and has remained event-free with dual antiplatelet therapy (aspirin and prasugrel).
Conclusion:
GuidePlus offers excellent flexibility and crossability for managing STEMI in ectatic and tortuous arteries when conventional devices fail.
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