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Case Report
 
Successful bail-out stenting of severe stenosis of the left main trunk coronary artery using guiding catheter exchange with the anchor balloon technique
Daizaburo Yanagi1, Takeshi Serikawa2, Masanori Okabe3, Yusuke Yamamoto4
1MD, PhD, Chief Resident Physician, Department of Cardiology, Cardiovascular and Aortic Center of Saiseikai Fukuoka General Hospital, Fukuoka, Japan.
2MD, Ph.D, Manager of the Catheterization Laboratory, Department of Cardiology, Cardiovascular and Aortic Center of Saiseikai Fukuoka General Hospital, Fukuoka, Japan.
3MD, PhD, Assistant Director, Department of Cardiology, Cardiovascular and Aortic Center of Saiseikai Fukuoka General Hospital, Fukuoka, Japan.
4MD, PhD, Director, Department of Cardiology, Cardiovascular and Aortic Center of Saiseikai Fukuoka General Hospital, Fukuoka, Japan.

doi:10.5348/ijcri-201458-CI-10015

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Daizaburo Yanagi
1-3-46 Tenjin, chuo-ku
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Fukuoka 810-0001
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Phone: +81- 92-771-8151
Fax: +81-92-716-0185

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How to cite this article
Yanagi D, Serikawa T, Okabe M, Yamamoto Y. Successful bail-out stenting of severe stenosis of the left main trunk coronary artery using guiding catheter exchange with the anchor balloon technique. Int J Case Rep Images 2015;6(6):376–380.


Abstract
Introduction: Trans radial intervention (TRI) is less invasive. However, percutaneous coronary intervention (PCI) operators may be concerned that trans femoral approach (TFI) is better than TRI according to the state of the patients, for example the patients with acute coronary syndrome (ACS) under the shock state, with severe winding subclavian artery and with the spasming radial artery.
Case Report: We herein report a case of an unstable angina and acute heart failure. Coronary angiography (CAG) revealed evidence of 90% ostial stenosis of the left main trunk (LMT). But we were unable to engage a 6 Fr guiding catheter (GC) because of severe tortuosity of the left subclavian artery. Therefore, we attempted intracoronary passage of a 4 Fr JL3.5 catheter exchange the 4 Fr diagnostic catheter with a 6 Fr GC using an extension wire. However, before entering the left coronary artery, the guidewire coiled around the catheter, which prolapsed; therefore, the 6 Fr GC could not be engaged. We carefully inserted a 3.0-mm semi-compliant balloon up to the LMT lesion without GC support and were able to engage the GC by the anchor balloon technique. The process took approximately 5 s and the patient's hemodynamic state were not affected. TRI or a downsizing stenting system is essential for patients in whom the approach site is limited in size.
Conclusion: The use of an extension wire after insertion of the diagnostic catheter and the anchor balloon technique has been successful in limited cases when insertion of GC is difficult.

Keywords: Trans radial intervention, Acute coronary syndrome, Left main trunk, Anchor balloon technique, Guiding catheter exchange

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Author Contributions
Daizaburo Yanagi – Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Masanori Okabe – Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Takeshi Serikawa – Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Yusuke Yamamoto – Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2015 Daizaburo Yanagi et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.