Guideliner microcatheter to improve back-up support during a complex coronary stenting procedure through a tortuous left internal mammary graft.

Back-up support during percutaneous coronary interventions (PCI) is one of the keys for successful intervention. Extra back-up support guiding catheters, deep intubation, buddy wires, and other more complex techniques are usually used to improve this support. Left anterior descending (LAD) artery PCI through the left internal mammary artery (LIMA) are rarely performed because many operators feel reluctant to instrument a disease-free LIMA graft risking iatrogenic complications by passing wire, balloons, and stents to the diseased distal LAD. Improving back-up support during LIMA-LAD PCIs is often challenging because in this particular setting the distance between the LAD lesion and the guiding catheter is exceedingly long. We report a case of a challenging PCI of the LAD through a patent and disease-free LIMA graft. After multiple failed attempts to cross the LAD lesion with conventional stent deployment techniques, we successfully finished the stenting procedure using the Guideliner microcatheter (Vascular Solutions) as a guiding extension through the LIMA graft. With this case, we illustrate that this microcatheter dramatically improves the back-up support, allowing stent deployment also in very difficult settings as in tortuous LIMA grafts.