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Patient initials or identifier number
Relevant clinical history and physical exam
This is a 70-year-old gentleman, known a history of hypertension and dyslipidemia. He complained of effort angina since December 2014. His family doctor referred to our hospital for stable effort angina. His general condition was good. His heart sounds no murmur, lung sound was clear. He had no leg edema.
Relevant test results prior to catheterization
His ECG showed normal sinus rhythm, non-Q wave, no ST-T change. His chest X-ray showed no cardiomegaly, no congestion. His coronary CT showed total calcium score was over 1700; especially right coronary artery (RCA) was over 900.
Relevant catheterization findings
He underwent for a coronary angiogram (CAG) on Feb 2015. There were severe stenosis in proximal RCA and circumflex (Cx). There is moderate stenosis in a left main trunk to LAD. His coronary artery had heavy calcium. He did not keen for bypass surgery, so we performed Percutaneous Coronary Intervention (PCI). First, we performed PCI to RCA severe calcified tortuous lesion on Mar 2015.
We used short AL-1 7F guiding catheter from the femoral approach. We opened the severe calcified stenosis by the 3.5 mm non-compliant balloon. Then we implanted 2DES to RCA under mother-child technique by using the Guide liner catheter. We tried to post-dilatation with 3.75 mm non-compliant balloon. However, it could not pass the lesion because the balloon tip hit the stent strut. We tried to pass it with the Guide liner backup but even this technique the balloon tip stuck the stent strut. We changed the wire to Wiggle wire. Finally, this balloon could pass to the distal RCA without Guide liner backup. We could succeed PCI to RCA severe calcified tortuous lesion.
It is sometimes difficult to pass any devices for PCI to calcified tortuous lesions. There are some techniques for these cases. In these cases, we have to get the strong guiding catheter backup, for example, anchor balloon technique, buddy wire technique, mother and child technique. Nevertheless, even performed these techniques some devices could not pass the lesion because of the wire bias. We experienced a useful case of Wiggle wire for PCI to RCA severe calcified tortuous lesion. In conclusion, Wiggle wire can change the wire bias because of the unique wire design; therefore, it is useful for PCI to a severe calcified tortuous lesion.