Background and Aims Coronary artery ectasia poses unique challenges during primary percutaneous coronary intervention for ST‐segment elevation myocardial infarction (STEMI), owing to thrombus burden and vascular tortuosity. This case demonstrates successful reperfusion using a flexible, hydrophilic‐coated guide catheter extension (GuidePlus, Nipro, Osaka, Japan). Methods A 45‐year‐old man with inferior STEMI had complete occlusion of a severely ectatic (6.5 mm, 1.8× reference) and tortuous RCA with a ‘shepherd’s crook’ morphology. The conventional GuideLiner failed to cross. GuidePlus, a soft and hydrophilic extension, enabled thrombus aspiration and intracoronary urokinase (240,000 IU) delivery. A 4.0 × 28‐mm drug‐eluting stent (Ultimaster, Terumo) was deployed and postdilated (5.0‐mm NC balloon). Results The GuidePlus enabled smooth navigation, direct aspiration and thrombolysis. Final angiography confirmed TIMI Grade 3 flow with minimal residual thrombus. The patient was discharged uneventfully and has remained event‐free with dual antiplatelet therapy (aspirin and prasugrel). Conclusion GuidePlus offers excellent flexibility and crossability for managing STEMI in ectatic and tortuous arteries when conventional devices fail.
Toyama et al. (Thu,) studied this question.
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