Shinozaki Mariko, Miki Keita, Ikeda Shohei, Sato Koichi, Takeda Morihiko
Department of Cardiovascular Medicine, International University of Health and Welfare Hospital, Nasushiobara, Tochigi, Japan.
J Cardiol Cases. 2025 Jun 21;32(3):109-113. doi: 10.1016/j.jccase.2025.06.006. eCollection 2025 Sep.
Successful percutaneous coronary intervention (PCI) requires selecting an appropriate guiding catheter to ensure adequate back-up support and optimal visualization. PCI for saphenous vein grafts (SVGs) is particularly challenging because of factors such as acute angulation at the anastomosis and severe stenosis. We herein describe a novel approach utilizing an inverted Amplatz left (AL)-1.0 guiding catheter to achieve coaxial alignment in a patient with an acute SVG-to-aorta angle and significant stenosis at the SVG entry site. The patient, a man in his mid-60s with a history of coronary artery disease, had undergone multiple PCI procedures and coronary artery bypass grafting, including SVG to the right coronary artery. He presented with unstable angina caused by severe stenosis at the SVG anastomosis. Standard Judkins right-4.0 and AL-1.0 catheters failed to achieve the coaxial alignment necessary for adequate back-up support. However, by inverting the AL-1.0 catheter, coaxial alignment was successfully achieved, enabling PCI with stent deployment. This inverted AL catheter technique is a simple, cost-effective method for addressing complex SVG PCI cases and may expand the options available for managing challenging PCI procedures.
Achieving coaxial alignment with standard guiding catheter manipulation during percutaneous coronary intervention for a saphenous vein graft (SVG) can be challenging. In our case, inverting the Amplatz left guiding catheter allowed precise coaxial alignment with the SVG, enabling successful treatment in a complex scenario. This simple, cost-effective, and practical technique offers a valuable option for percutaneous coronary intervention in SVGs with sharp aortic branching angles.
成功的经皮冠状动脉介入治疗（PCI）需要选择合适的引导导管，以确保足够的支撑和最佳的视野。由于诸如吻合处急性成角和严重狭窄等因素，隐静脉移植血管（SVG）的PCI尤其具有挑战性。我们在此描述一种新颖的方法，即利用倒置的Amplatz左（AL）-1.0引导导管，在一名SVG与主动脉夹角急性且SVG入口处严重狭窄的患者中实现同轴对齐。该患者为一名60多岁的男性，有冠状动脉疾病史，曾接受多次PCI手术和冠状动脉旁路移植术，包括SVG至右冠状动脉。他因SVG吻合处严重狭窄而出现不稳定型心绞痛。标准的Judkins右-4.0和AL-1.0导管未能实现足够支撑所需的同轴对齐。然而，通过倒置AL-1.0导管，成功实现了同轴对齐，从而能够进行支架置入的PCI。这种倒置的AL导管技术是处理复杂SVG PCI病例的一种简单、经济有效的方法，可能会扩展处理具有挑战性的PCI手术的可用选项。
在隐静脉移植血管（SVG）的经皮冠状动脉介入治疗中，通过标准引导导管操作实现同轴对齐可能具有挑战性。在我们的病例中，倒置Amplatz左引导导管可与SVG实现精确的同轴对齐，从而在复杂情况下成功进行治疗。这种简单、经济有效且实用的技术为具有尖锐主动脉分支角度的SVG经皮冠状动脉介入治疗提供了一个有价值的选择。
