Kazma Hasan, Haidar Hussam, Berry Vincent J, Mohammed Malek, Rachid Abbas
Department of Cardiology, Bahman University Hospital, Beirut, LBN.
Department of Medicine, Faculty of Medical Sciences, Lebanese University, Beirut, LBN.
Cureus. 2025 Jul 10;17(7):e87676. doi: 10.7759/cureus.87676. eCollection 2025 Jul.
The advancement of drug-eluting stents (DES) to distal, severely calcified, and tortuous coronary artery lesions presents a significant challenge in interventional cardiology. Techniques such as extra-backup catheters, buddy wires, and guiding extension catheters are commonly employed to overcome these difficulties. When these conventional methods fail, the stepwise approach enhanced by repeated proximal to distal balloon anchoring helps advance the guiding extension catheter deep into the coronary artery, allowing the delivery of DES to the distal calcified lesions even in tortuous arteries, and serves as an effective bailout strategy. The stepwise approach enhanced by repeated proximal to distal balloon anchoring is used to overcome difficulties in DES delivery. It allows deep advancement of the guiding extension catheter into the coronary artery over the shaft of the anchored (inflated) balloon, facilitating DES delivery. This case report details the percutaneous coronary intervention (PCI) of the right coronary artery (RCA) in a 69-year-old male patient with multiple severe diffuse calcified stenosis. Despite initial attempts with a Judkins right curve (JR4) 6 French guiding catheter (Medtronic, Inc., Minneapolis, MN) and a buddy wire technique, DES delivery was unsuccessful, given that the guiding catheter support was unstable when the DES was advanced into the artery. Thus, to facilitate DES delivery, a guiding extension catheter was used, but it failed to advance into the RCA. However, using the stepwise approach with repeated proximal to distal balloon anchoring allowed deep advancement of the guiding extension catheter into the RCA over the anchored (inflated) balloon shaft. This anchored balloon technique was done three times starting at the proximal part of the RCA and advancing the guiding extension catheter to proximal, mid, and finally distal part of the vessel, ultimately allowing the successful placement of three DES from the distal to the proximal part of the vessel, demonstrating the technique's efficacy in overcoming complex anatomical challenges. At the end of the procedure, all lesions were successfully stented with no residual stenosis and a thrombolysis in myocardial infarction (TIMI) III flow in the RCA, and the patient was stable hemodynamically with no chest pain.
药物洗脱支架（DES）应用于远端、严重钙化及迂曲的冠状动脉病变，这对介入心脏病学而言是一项重大挑战。诸如额外支撑导管、辅助导丝及引导延长导管等技术常被用于克服这些困难。当这些传统方法失效时，通过反复从近端到远端的球囊锚定强化的逐步推进方法有助于将引导延长导管深入冠状动脉，即使在迂曲的动脉中也能将DES输送至远端钙化病变处，这是一种有效的补救策略。通过反复从近端到远端的球囊锚定强化的逐步推进方法用于克服DES输送中的困难。它能使引导延长导管在锚定（充气）球囊的杆部上方深入冠状动脉，便于DES输送。本病例报告详细介绍了一名69岁男性患者右冠状动脉（RCA）的经皮冠状动脉介入治疗（PCI），该患者存在多处严重弥漫性钙化狭窄。尽管最初尝试使用了6F Judkins右弯（JR4）引导导管（美敦力公司，明尼阿波利斯，明尼苏达州）及辅助导丝技术，但当DES推进至动脉时，由于引导导管支撑不稳定，DES输送未成功。因此，为便于DES输送，使用了引导延长导管，但它未能推进至RCA。然而，采用反复从近端到远端的球囊锚定的逐步推进方法，使引导延长导管在锚定（充气）球囊杆部上方深入RCA。这种锚定球囊技术从RCA近端开始进行了三次，将引导延长导管推进至血管的近端、中段，最终至远端，最终成功地从血管远端至近端放置了三个DES，证明了该技术在克服复杂解剖挑战方面的有效性。手术结束时，所有病变均成功置入支架，无残余狭窄，RCA的心肌梗死溶栓（TIMI）血流为III级，患者血流动力学稳定，无胸痛。
