Percutaneous Coronary Intervention Difficulty in Tortuous Coronary Anatomy: A Case Report

One of the relatively common anatomical variants of coronary vessels that is often overlooked in clinical practice is coronary artery tortuosity (CAT). CAT can have a significant impact on coronary blood flow and procedural outcomes during percutaneous coronary intervention (PCI). It is defined by bends, curves, or loops within the coronary vasculature that can lead to increased vascular resistance. These structural changes can impair myocardial perfusion even in the absence of obstructive coronary disease. From an interventional perspective, tortuosity can present considerable technical difficulties, particularly in advancing guidewires, balloons, and stents through the affected segments. We describe the case of a patient whose PCI was complicated by extensive tortuosity involving the right coronary artery. She had high amounts of thrombosis that were impacting the blood flow, but the tortuosity of her vessel was making it hard to make the lumen patent again. Multiple attempts had to be made before adequate blood flow was achieved. This case highlights the often-underestimated impact of CAT on both coronary perfusion and interventional success. Recognizing this anatomical feature early and adapting the procedural strategy accordingly can significantly improve the chances of success and reduce the risk of complications in patients undergoing PCI.