Anterior-Posterior Relationships of Dual Guiding Catheters

BACKGROUND: A 3-dimensional (3D) understanding of device positioning is essential for successful percutaneous coronary intervention. We developed a novel method to visualize the 3D relationship between dual guiding catheters from orthogonal fluoroscopic images using 3D computer-aided design software. CASE SUMMARY: We present 4 complex percutaneous coronary intervention cases where the right coronary artery catheter was initially positioned posterior to the left coronary artery catheter. This caused instability or disengagement; however, repositioning the right coronary artery catheter anteriorly improved coaxial alignment and achieved system stability, enabling procedural success. DISCUSSION: Intentionally inverting this anterior-posterior relationship-either by exchanging the catheter shape or via manual re-engagement manipulation-successfully optimized coaxial alignment and system stability, allowing successful lesion completion. TAKE-HOME MESSAGES: The 3D spatial relationship of dual guiding catheters should be recognized from 2 orthogonal fluoroscopic images. Furthermore, strategic configuration inversion should be considered when necessary to optimize catheter stability and procedural success.