Tools and techniques for angioplasty of anomalous origin of right coronary artery

Abstract

ObjectiveTo explore the technical challenges in percutaneous coronary intervention of anomalous origin of right coronary artery (AORCA). MethodsThe study cohort consists of 20 patients who underwent PCI for an angiographically significant stenosis in AORCA between 2010 and 2014. The procedural details such as access, hardware, techniques, radiation time, volume of contrast and complications have been assessed. ResultsThe most frequent site for AORCA is from the right coronary sinus (55%), followed by the left coronary sinus (30%), ascending aorta (10%) and non-coronary sinus (5%). Male to female ratio was 3:1. Mean age of the study population was 61.1 ± 10years. PTCA was done successful in 18 cases (90%). Angioplasty was performed transradial in 60% and transfemoral in 40%. The average number of guide catheters used were two. The guide hooked the coronary selectively in 40%, off ostium in 55% and in 5% it was deep engaged. Buddy wires to enhance the guide support was used in 40% and balloon predilatation was needed in 50% cases. A staged procedure was needed in 3 patients (15%). The average flouro time was 22 min, the mean volume of contrast volume used was 124 ml. ConclusionsPCI of AORCA is technically challenging but feasible with reasonable amount of contrast and radiation. Proper pre-intervention localisation of ostium and selection of suitable guide catheter is the crux of success. Radial approach is equally effective and safe using nearly the same guide catheters and hardware as by femoral approach.