PCI of a Tortous Unprotected Left Main and Right Coronary Artery in a Patient With Cardiogenic Shock

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About the Video:
This is a case of a 64-year-old morbidly obese man who presented with stable angina. Coronary angiography showed severe disease of the left main and right coronary arteries, with marked tortuosity at the left anterior descending artery origin. The patient was admitted for cardiac surgery evaluation but subsequently developed cardiogenic shock and was referred for salvage percutaneous coronary intervention.

After an intra-aortic balloon pump was inserted, the right coronary artery was successfully stented with difficulty due to marked ischemia during balloon inflations. Wiring into the left anterior descending artery was extremely challenging due to marked ostial tortuosity. Insertion of a Finecross microcatheter enabled wire steering into the left anterior descending artery. In spite of transient circumflex artery occlusion during balloon angioplasty, the patient remained hemodynamically stable. After stenting, an excellent final angiographic result was achieved, followed by complete recovery.

The case highlights the following: (1) First treating the right coronary artery may decrease the risk of subsequent left main intervention, and (2) the highly flexible Finecross microcatheter can facilitate wiring through markedly tortuous coronary anatomy.

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