Steerable Microcatheter to Negotiate a Hairpin Angle During Primary Percutaneous Coronary Intervention

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J INVASIVE CARDIOL 2024. doi:10.25270/jic/24.00237. Epub August 15, 2024.

A 50-year-old man with family history of coronary artery disease underwent primary percutaneous coronary intervention (PPCI) due to an inferior ST-elevation myocardial infarction (STEMI). Coronary angiography revealed an occluded left circumflex artery (LCx) (Figure A, arrow).

Wiring of the LCx proved impossible due to an extremely acute bifurcation angle between the left main artery (LM) and the LCx, measuring 43° in left anterior oblique and 33° in anteroposterior caudal projections (Figure A and B, Video 1). The hairpin bifurcation of the LM/LCx and the presence of proximal ectasia caused guidewire prolapse to the LAD. Despite the use of a dual lumen microcatheter, the guidewire could not be advanced into the LCx and prolapsed to adjacent branches (Figure C, arrow).

We aimed to utilize a Venture steerable microcatheter (SM) (Teleflex) to steer its tip to the LCx ostium. The SM was advanced up to the ostial LAD over a guidewire. Subsequently, the guidewire was retracted, and the tip of the SM was carefully deflected at an angle of 90° while the shaft was torqued to the LCx ostium (Figure D, arrow; Video 2). This maneuver requires caution to avoid microcatheter-induced coronary dissection. With the SM in place, adequate support was provided to navigate the guidewire to the LCx (Figure E, arrow; Videos 3 and 4). PPCI with stent implantation was performed (Figure F, arrow). The clinical course was uneventful, and the patient was scheduled for staged PCI of the LAD and RCA.

Affiliations and Disclosures

Sotirios C. Kotoulas, MD; Dimitrios Iliopoulos, MD; Paschalis Latsios, MD; Aikaterini Peteinaki, MD; Efthymia Koutsogiannaki, MD; Andreas S. Triantafyllis, MD, PhD

From the Department of Interventional Cardiology, Asklepeion General Hospital, Athens, Greece.

Disclosures: The authors report no financial relationships or conflicts of interest regarding the content herein.

Acknowledgments: The authors would like to thank Mrs Anastasia Patsaki (Cathlab RN) and Mrs Eugenia Iliopoulou (Cathlab Radiographer) for their invaluable contribution during the procedure.

Consent statement: The authors confirm that informed consent was obtained from the patient for the intervention described in the manuscript and to the publication thereof.

Address for correspondence:  Andreas S. Triantafyllis MD PhD, Department of Cardiology, Asklepeion General Hospital, Leoforos Vasileos Pavlou 1, PC 16673, Voula, Athens, Greece. Email: andtridoc@yahoo.gr; X: @andreas_triant