Case 106: PCI Manual - Tortuosity troubleshooting

A patient with prior CABG presented with NSTEMI and was found to have severe lesion in a highly tortuous native coronary artery distal to the SVG anastomosis. The SVG was initially engaged with a 6 French Hockeystick guide catheter. The lesion could not be wired with a Sion blue guidewire but was successfully crossed using a Sion black wire. Despite using a Wiggle wire and a 6 French guide catheter extension no balloon (including a Sapphire 1.0 mm balloon) could be delivered through the lesion. Over the Wiggle wire the guide was changed to a 7 French AL1 guide catheter that provided better support. Using a 6 French guide extension and the Sion black as buddy wire the Sapphire 1.0 mm balloon was delivered to the lesion, but ruptured. A 1.5 and a 2.0 mm balloon could then be delivered to the lesion, followed by delivery of a 2.25x13 mm Orsiro stent that partially covered the lesion. However, a 2nd Orsiro wire could not be delivered until after the Wiggle wire was exchanged for a Grand Slam guidewire. A nice final result was achieved.