Innovative catheter modification for engaging an anomalous right coronary artery: a case report

Anomalous right coronary artery (RCA) arising from the left sinus of Valsalva presents a challenge during angiography, often leading to failed engagement, prolonged procedure time, and delayed reperfusion. This case highlights an innovative technique in which a standard guide catheter was manually modified to mimic a Leya catheter when the dedicated device was unavailable, allowing timely revascularization.

A 47-year-old man presented with chest pain and elevated troponin, consistent with non-ST-elevation myocardial infarction. Angiography showed an anomalous RCA taking off anterior and superior to the left main coronary artery. Several standard diagnostic and guiding catheters failed to engage the vessel; the procedure was then switched from radial to femoral access, and an Amplatz Left 1 (AL1) guide catheter was manually modified by applying a 45-60° right-angled twist at the tip to reproduce the curvature of a Leya catheter. This modification allowed stable engagement of the RCA and successful percutaneous coronary intervention.

In patients with anomalous RCA where standard catheters fail, manual modification of a guide catheter to achieve optimal engagement can be a useful alternative when a dedicated design is unavailable. Femoral access is preferred in difficult cases, especially with anomalous RCA, as it provides greater stability and facilitates successful engagement.