Percutaneous Coronary Intervention for High Takeoff Left Main Coronary Artery: A Case Report

Percutaneous coronary intervention (PCI) for high takeoff left main is challenging, as it poses difficulties with the engagement of the guiding catheter and establishment of backup support. This report examines the case of a 53-year-old woman with history of anterior wall myocardial infarction with a ventricular septal defect (VSD), who was treated with left anterior descending (LAD) angioplasty and VSD device closure done 4 years back, and now she presented with unstable angina. After successful engagement of 5F Tiger diagnostic catheter through a right radial artery, the angiography revealed an 80% stenosis of the proximal LAD and in-stent restenosis 70% of mid-LAD. The authors tried to engage the left coronary system through the right femoral artery with 6F Judkins left, 6F Amplatzer left, 6F EBU, and 6F XBU. They could not cannulate because of high takeoff left main, so they switched to right radial access. Then they engaged a 6F 3.5 EBU catheter. Due to the weak backup support of the guiding catheter, they used another wire to stabilize it and the stent was implanted successfully. This is one of the rare case reports of PCI for high takeoff left main.