Utility of catheter extension devices in coronary artery anomalies

We report the case of a 72-year-old woman with a history of hypertension and dyslipidemia, who came to the outpatient clinic complaining of chest pain. Exercise stress test was positive. Coronary angiography (Figure 1A) by radial approach showed a right coronary artery (RCA) with an anomalous origin at the left sinus of Valsalva, next to the origin of the left main coronary artery, with severe stenosis in the middle segment (arrow). Due to its anomalous origin, selective catheterization of the RCA could not be achieved with any type of guide catheter; the AmplatzLeft-1 allowed the best approach. The use of a catheter extension device (Figure 1B, arrow) enabled selective intubation of the anomalous ostium, advancing the angioplasty balloon and pre-dilation of the stenosis. Subsequently, with the help of the catheter extension device, we implanted a drug-eluting stent in the RCA (Figure 1C) with an excellent final angiographic result (Figure 1D).