RCA Tortuosity: The Complicated Route to the Lesion

The RCA was engaged with an JR4 6Fr guiding catheter through a right radial approach. A Whisper MS 0.014" hidrophilic guidewire was advanced through the proximal severe tortuosity to distal lesion in IVP (figure 2). The stenosis was predilated with an Apex 2,0 x 18 mm ballon (figure 3) without significant difficulties in navigation through proximal RCA segments however subsequently was impossible to advance the Promus Element Plus 2,5 x 18 mm stent. We decided to advance the Apex ballon again to the stenosis and using the "Anchoring technique" canulated the proximal and mis segments of the RCA with de JR4 guiding catheter (figure 4). After the stent advance without difficulties and was succesfully implanted with excelent angiographic results (figure 7 and 5). Finally we pullback the catheter to the ostium and perform an angiogram to descart coronary dissection and then retired the guire (figure 6).