PCI for in-stent restenosis of an anomalous right coronary artery.

Coronary angioplasty for congenital anomalies of the coronary arteries (ANOCOR) remains a technically demanding procedure due to the difficulties associated with selective cannulation of the coronary ostium and achieving adequate support for the guide catheter. We report a case of in-stent restenosis in a proximal connection anomaly of the right coronary artery arising from the left coronary sinus, which was successfully treated using an innovative telescopic technique. A 63-year-old female patient, presenting with multiple cardiovascular risk factors and having previously undergone angioplasty of this right coronary artery, was referred for recurrent angina and exertional dyspnea. Myocardial scintigraphy revealed ischemia of the inferior wall, and coronary angiography demonstrated significant in-stent restenosis of the proximal and middle segments of the right coronary artery. Angioplasty was performed via the right femoral approach using a 7 Fr introducer. Selective intubation of the coronary ostium was achieved using a telescopic configuration consisting of inserting a 5 Fr internal mammary guide catheter within a 7 Fr 3.5 Extra Backup (EBU) guide catheter, allowing for optimal coaxial alignment and satisfactory support. This strategy allowed for lesion preparation followed by the implantation of two drug-eluting stents, resulting in an excellent angiographic outcome and significant clinical improvement.