PMC4857309_01
(a) Diagnostic coronary angiogram of right coronary artery and midportion stenosis site (arrow), left anterior oblique view, (b) left coronary artery and right coronary artery originated from left coronary cusp (arrow), right anterior oblique view, (c) steam-deformed Judkins-left catheter and (d) anchoring to coaxially engage Judkins-left guiding catheter, left anterior oblique view.
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Coronary angiogram with 4Fr diagnostic catheter, Heartcath  (Terumo, Tokyo, Japan) for both right and left coronary artery revealed an anomalous RCA origin from the left coronary cusp with 99% stenosis in the midportion of the RCA (Figure 1(a) and (b); Online Video 1). Amplatz-left or Judkins-left diagnostic catheter, we proceeded to PCI with a 6-F Profit  Judkins-left guiding catheter (Goodman, Gifu, Japan), deformed by hot steam (Figure 1(c)). After bending it with hot steam, I put it in normal saline to cool for fixing the shape in the blood with the temperature around 37 . Then, we anchored a predilatation 2.0 x 12-mm2 balloon (Lifespear HP  (Japan Lifeline, Tokyo, Japan)) to engage coaxially (Figure 1(d); Online Video 2).
(a) Delivering stent with deeply seated GuideLiner (arrow), left anterior oblique view, (b) coronary angiogram with suspected coronary injury (arrow) after stenting, left anterior oblique view, (c) delivering the second stent in the proximal lesion, left anterior oblique view and (d) final angiogram after successfully stenting.
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Next, we deeply seated GuideLiner to successfully implant the stent (Figure 2(a) and (b); Online Video 5). After stenting, however, angiography revealed that the GuideLiner had induced injury in the proximal portion of the RCA (Figure 2(b), arrow; Online Video 6). Therefore, we considered it necessary to implant within the proximal portion of the RCA, and we inserted a 2.5 mm x 20 mm drug-eluting stent, Promus Premier (Boston Scientific) (Figure 2(c); Online Video 7). The patient's final coronary angiogram showed successful stenting in the proximal and midportion of the RCA (Figure 2(d); Online Video 8).