TECHNIQUE OF DEEP SEATING OF CATHETER TO DELIVER STENT

• This patient presented with total occlusion of the right coronary artery.
• The procedure was carried out via the right radial access.

The baseline angiography shows a long blockage

2 prox balloon anchor – Due to inadequate support from the guiding catheter…

4 deep seating of guide – Very poor support from guiding catheter

Due to extreme lack of support from guiding catheter, delivery of stent was not possible. To overcome this problem, a distal anchoring balloon was deployed and extreme deep seating of guiding catheter was achieved.

Stent deployed

With the deep seating of guide, stent is able to be deployed in the RPL branch

After successful stent implantation the RCA is fully opened

CONCLUSION

• When support of guiding catheter is inadequate.
• The options can be to change to a different shape guide, but this will incur cost.
• One can change to femoral approach, but this will cause extra pain and cost.
• Deep seating of guide is commonly used, but such deep seating requires more care and skill to achieve.
• A complex case can still be successfully completed via radial access.