Case3: Shepherd Crook Type RCA, 60 year old male


A case of acute myocardial infarction was transferred to another hospital. ECG showed ST elevation in II, III, and aVF leads. Emergency PCI was started. However, due to shepherd crook shape of RCA, PCI failed using Amplatz L guiding catheter. Then the patient transferred to our hospital.

Initial angiography in another hospital

RCA was shepherd crook type with severe tortuosity

Failed PCI in another hospital

Amplatz L was used. A guidewire passed the lesion. However, even a balloon could not pass the lesion due to weak backup force.

Final angiography showed TIMI 0 flow.

The patient was transferred to our hospital. A young operator performed PCI using 7 Fr Ikari L. Backup force was still insufficient. Then anchor balloon technique was used to pass a balloon. After POBA, TIMI 3 flow was achieved indicating successful primary PCI. However, stent passage was impossible.

After POBA, TIMI 3 achieved.

Three days later, Dr. Ikari successfully performed PCI using 6 Fr Ikari L without anchor balloon by using power position of Ikari L.

Advanced use of Ikari L

7F IL + anchor
Standard position

6F IL at power position


Amplatz L failed for this severe tortuous shepherd crook type RCA.
POBA was successful using 7F Ikari L with anchor balloon technique at standard position, but stent was impossible to advance.
Dr. Ikari simply performed stent implantation successfully using 6F Ikari L at the power position without anchor balloon.