Dual-Lumen Catheter and Floating-Wire Technique to Access Protruding Aorto-Ostial Stent

J INVASIVE CARDIOL 2023;35(5):E275-E276

Key words: right coronary artery, stent protrusion

A 56-year-old man with exertional angina underwent coronary angiography, which showed severe restenosis within a previously placed stent in the ostial right coronary artery (RCA). Selective engagement of the RCA with a JR4 diagnostic catheter was difficult due to excessive protrusion of the previous stent into the aorta (Figure 1A). A 6-Fr, JR4 guide catheter was used for intervention.

A workhorse guidewire was able to enter the conus branch through a protruding side-strut. Wiring the RCA proved difficult and could only be done through a protruding side-strut (Figure 1B). A Sasuke dual-lumen catheter (DLC; Asahi Intecc) was loaded onto the RCA guidewire, but the central stent lumen could not be wired successfully (Figure 1C). The DLC was then loaded onto a floating wire, and the central stent lumen was successfully accessed with a second guidewire (Figure 1D; Video Series).

Intravascular ultrasound (IVUS) confirmed wiring of the central lumen, with 4 mm of protrusion into the aorta. The ostial RCA had a minimal lumen area of 3.2 mm², likely due to mechanical compression at the aorto-ostial junction (Figure 2A; Video Series). A 3.5- x 14-mm drug-eluting stent was deployed and postdilated with a 4.0-mm non-compliant balloon at high pressure. IVUS showed minimal stent area of 6.8 mm², with stent expansion of 93% (Figures 2B and 2C; Video Series).

Percutaneous coronary intervention in the setting of previous aorto-ostial stenting can be difficult, especially if there is excessive stent protrusion. Various techniques have been described, including double-wire technique, double-guide snare technique, side-strut sequential ballooning technique, and guide-extension facilitated side-strut stenting.^1-5 These techniques can sometimes be complicated, and intervention through a side-strut may lead to excessive stent deformation or avulsion of the protruding segment. Our novel technique uses a DLC and floating wire to back the JR4 guide away from the protruding stent while maintaining stability for another guidewire to enter the central lumen.

Affiliations and Disclosures

From Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Wu reports research funding from OrbusNeich, Asahi Intecc, Abiomed; consulting honoraria from Boston Scientific and Abbott Vascular; member of the board of directors for the APCTO club. Dr Wong reports no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted September 15, 2022.

Address for correspondence: Bernard Wong, MBChB, Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China. Email: bernardwong@hotmail.co.nz

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