Protecting the LIMA During Scoring Balloon Delivery to the LAD Using an Integrated Microcatheter-Guide Extension

BACKGROUND: Percutaneous coronary intervention via the left internal mammary artery (LIMA) graft is technically challenging and carries a risk of graft injury, particularly during delivery of specialty balloons. CASE SUMMARY: A 40-year-old man with premature coronary artery disease and prior coronary artery bypass grafting 17 years ago presented with refractory angina. Coronary angiography demonstrated severe left anterior descending artery stenosis distal to the LIMA anastomosis. After inadequate lesion expansion, scoring balloon was required. To minimize the risk of LIMA graft trauma during device delivery, an integrated microcatheter-guide extension system was advanced into the distal LIMA, allowing safe delivery of the scoring balloon followed by stenting with excellent angiographic results. DISCUSSION: This case highlights a novel strategy to protect the LIMA graft during high-risk device delivery, using an integrated microcatheter-guide extension system. TAKE-HOME MESSAGE: Integrated microcatheter-guide extension systems may reduce the risk of LIMA graft injury and facilitate delivery of specialty balloons in complex percutaneous coronary intervention.