Guidezilla-Assisted Tracking of Guide Catheter for Tortuous and Angulated Subclavian-Brachiocephalic Artery During Transradial Intervention

J INVASIVE CARDIOL 2020;32(12):E377. 

Key words: anterior myocardial infarction, tortuous coronary anatomy

A 60-year-old woman with hypertension and type 2 diabetes mellitus presented with chest pain of 8-hour duration for anterior myocardial infarction. Immediate coronary angiography was performed via right radial artery. A 0.035˝ standard wire and 0.025˝ hydrophilic wire failed to pass the subclavian-brachiocephalic (SB) artery. Catheter angiography revealed a very tortuous and angulated SB artery (Figure 1A; Video 1), which was crossed with a 0.014˝ percutaneous transluminal coronary angioplasty (PTCA) floppy wire (Figure 1B; Video 2). However, the advancement of a 5 Fr diagnostic catheter and 6 Fr JL 3.5 guide catheter, as well as the balloon-assisted tracking technique (Figure 1C; Video 3) all failed. Finally, a 6 Fr Guidezilla catheter  (Boston Scientific) easily negotiated over 2 PTCA floppy wires down to the ascending aorta (Figure 1D) and the JL 3.5 guide catheter passed over the Guidezilla to the aortic root successfully (Videos 4-6). Coronary angiography showed a total occlusion of the mid left anterior descending (LAD) artery, which was stented (Figures 1E, 1F), and a normal right coronary artery (Figure 1G). Subsequent computed tomography (CT) scan confirmed the extremely tortuous and angulated SB artery. The patient was discharged uneventfully and was asymptomatic at 1-year follow-up. This case highlights the novel use of the Guidezilla catheter to facilitate guide catheter use during transradial intervention by overcoming a tortuous and angulated SB artery.

View the Supplemental Video Series Here

From the Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China. 

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted February 12, 2020.

Address for correspondence: Jincheng Guo, MD, Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, No. 82, Xinhua South Road, Tongzhou District, Beijing, China 101149. Email: guojcmd@126.com