ArticleEuropean heart journal. Case reports2026
Innovative catheter modification for engaging an anomalous right coronary artery: a case report.
Article in European heart journal. Case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Anomalous right coronary artery (RCA) arising from the left sinus of Valsalva presents a challenge during angiography, often leading to failed engagement, prolonged procedure time, and delayed reperfusion. This case highlights an innovative technique in which a standard guide catheter was manually modified to mimic a Leya catheter when the dedicated device was unavailable, allowing timely revascularization. Case summary: A 47-year-old man presented with chest pain and elevated troponin, consistent with non-ST-elevation myocardial infarction. Angiography showed an anomalous RCA taking off anterior and superior to the left main coronary artery. Several standard diagnostic and guiding catheters failed to engage the vessel; the procedure was then switched from radial to femoral access, and an Amplatz Left 1 (AL1) guide catheter was manually modified by applying a 45-60° right-angled twist at the tip to reproduce the curvature of a Leya catheter. This modification allowed stable engagement of the RCA and successful percutaneous coronary intervention. Conclusion: In patients with anomalous RCA where standard catheters fail, manual modification of a guide catheter to achieve optimal engagement can be a useful alternative when a dedicated design is unavailable. Femoral access is preferred in difficult cases, especially with anomalous RCA, as it provides greater stability and facilitates successful engagement.
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