PCI for in-stent restenosis of an anomalous right coronary artery

Area of Science:

• Interventional Cardiology
• Congenital Heart Disease
• Vascular Surgery

Background:

• Congenital anomalies of the coronary arteries (ANOCOR) present significant challenges for interventional procedures.
• Selective cannulation and guide catheter support are critical difficulties in ANOCOR angioplasty.
• In-stent restenosis is a known complication following coronary angioplasty.

Purpose of the Study:

• To describe a novel telescopic technique for treating in-stent restenosis in a complex coronary artery anomaly.
• To demonstrate the feasibility and efficacy of this technique in achieving optimal guide catheter support and coaxial alignment.
• To report the successful clinical outcome in a patient with recurrent angina due to in-stent restenosis.

Main Methods:

• A case report of a 63-year-old female with recurrent angina and in-stent restenosis of a right coronary artery anomaly.
• Utilized a 7 Fr 3.5 Extra Backup (EBU) guide catheter with a 5 Fr internal mammary guide catheter telescoped inside.
• Performed angioplasty via a right femoral approach, followed by drug-eluting stent implantation.

Main Results:

• The telescopic technique provided optimal coaxial alignment and satisfactory guide catheter support.
• Successful lesion preparation and implantation of two drug-eluting stents were achieved.
• The patient experienced an excellent angiographic outcome and significant clinical improvement.

Conclusions:

• The innovative telescopic technique is a viable solution for challenging coronary angioplasty cases, including in-stent restenosis in ANOCOR.
• This method enhances procedural success by improving catheter manipulation and stability.
• It offers a promising strategy for managing complex coronary artery anomalies and their complications.