Bailout Access to an Anomalous-Origin Occluded Right Coronary Artery Using Anchor Wire Stabilization in Cardiogenic Shock.

OBJECTIVE

To present a reproducible bailout technique using anchor wire stabilization in the left anterior descending artery for accessing aorto-ostial right coronary artery (RCA) occlusion with anomalous origin in inferior-right ventricular ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock.

KEY STEPS: 1) Anchor a 6-F Amplatz left 1.0 guiding catheter in the left coronary system with a Sion guidewire for stability. 2) Perform controlled clockwise rotation and probing of the aortic root using a Runthrough guidewire to cross the occluded anomalous RCA ostium. 3) Perform balloon angioplasty followed by stent implantation to achieve TIMI flow grade 3 and hemodynamic stabilization.

POTENTIAL PITFALLS: The Amplatz left catheter and/or stiffer wires could jeopardize the aortic root and coronary ostium. Early aortography is recommended if the RCA appears "absent" on nonselective injections to detect ostial occlusion and/or anomalies.

TAKE-HOME MESSAGES: Acute aorto-ostial occlusion of an anomalous RCA may cause inferior-right ventricular STEMI and apparent angiographic "absence". This anchor-assisted probing maneuver offers a safe, effective bailout strategy for difficult coronary access in unstable patients.