Retrograde approach via left internal mammary artery using a 5 Fr guiding catheter.

ABSTRACT

A 64-year-old female, who had undergone CABG previously, was admitted to our hospital because of non-ST elevation myocardial infarction with acute heart failure. The SVG-RCA was judged the culprit vessel because of the angiographical thrombus. However, primary percutaneous coronary intervention (PCI) in the SVG-RCA had a high risk of distal embolism and might have had caused critical slow flow. Primary PCI to the native right coronary artery (RCA) with retrograde approach using the septal channel from left anterior descending artery bypassed by LIMA was successfully performed. A 5 Fr JR-4.0 guiding catheter was deeply engaged to the mid part of LIMA following the microcatheter, and the wire finally reached the distal part of RCA.