Successful percutaneous coronary intervention using an inverted Amplatz left type guiding catheter for cannulation into an acutely angled saphenous vein graft: A case report

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.

Learning objective

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.