Catheterization and Cardiovascular Diagnosis 18:18-19 (1989)

Large Coronary Artery Angioplasty

Arthur Calick, MD

Angioplasty of a large coronary artery required two side-by-side balloon catheters. An- gioplasty was performed using a single recently developed large lumen guide catheter in a vessel that was difficult to cannulate.

Key words: angioplasty, guiding catheter, hugging balloon

INTRODUCTION ing catheter recently developed by Interventional Medi- cine. The 0.088 in internal diameter allowed passage of a 2 mm probe and a 4 mm polyvinyl catheter, both made by USCI. The increased compliance of the polyvinyl catheter permitted a dimension of 4.3 mm when the bal- loon was inflated to 9 atm. Good stenosis resolution was obtained after several simultaneous balloon inflations

The “kissing balloon” technique has been described previously [ 11. The procedure usually involves two guid- ing catheters. We performed angioplasty in a patient with very large coronaries using a single large lumen guiding catheter and two side-by-side balloon catheters.

achieving a combined dimension of 6.3 mm in diameter CASE REPORT-PATIENT P.V.

A 50-year-old diabetic male presented with angina and an abnormal stress test. Coronary arteriography revealed an eccentric 75% stenosis in the proximal segment of the right coronary artery; the vessel diameter was 6.3 mm (Fig. 1). Measurements were made from the angio- graphic film using hand calipers and the known diameter of a 7 French catheter. The vessel was cannulated with great difficulty using a 9 French Judkins right #4 guid-

Fig. 2. LAO projection. Simultaneous full expansion of both balloons side by side.

From the Department of Cardiology, Fountain Valley Region Medical Center, Fountain Valley, California.

Received November 2, 1988; revision accepted April 12, 1989.

Arthur Calick, M.D., is now at 17752 Beach Blvd., Suite 102 Hun- tington Beach, CA 92647.

Fig. 1 high-grade stenosis in the proximal portion of the vessel.

LAO projection. The huge right coronary artery shows a

0 1989 Alan R. Liss, Inc.

Large Artery PTCA 19

cases. A “hugging balloon” technique has been reported previously for large saphenous vein grafts requiring di- latation [2]. The ostia in those cases were easy to can- nulate and two guide catheters were readily used. In the current report, both diagnostic and guide catheter seating were extremely difficult, and balloon passage required guide catheter deep seating as well. A single guide cath- eter seemed most desirable in this circumstance. A re- cently developed large lumen guide catheter allowed easy positioning of 2 balloons in our case. We took ad- vantage of the increased compliance of the older polyvi- nyl catheters to achieve a diameter of 6.3 mm when both balloons were inflated side-by-side. Despite some con- cerns about the combined ellipsoid configuration and balloon placement, we were able to obtain a good an- giographic and clinical result.

Fig. 3. LAO projection. After dilatation good lumen patency is noted.

(Figs. 2, 3). Latter inflations were associated with no chest discomfort or ST segment elevations in contrast to dramatic initial ST segment elevations and chest pain.

DISCUSSION

Abnormally large coronary arteries are uncommon, and standard balloon sizes are not available for these

ACKNOWLEDGMENTS

I thank Bill Colditz, Dennis Brown, and Diana Sweeney for their able assistance.

REFERENCES

1. Meier, B: Kissing balloon coronary angioplasty. Am J Cardiol

2. Hartzler, G: Hugging balloons. Cathet Cardiovasc Diagn 15:52- 53:9 10-9 1 8, 1984.

54, 1988.