Percutaneous Coronary Intervention with Diagnostic Tiger Catheter in Anomalous Right Coronary Artery through Femoral Route: A Case Report

Anomalous right coronary arteries (ARCAs) are extremely rare in general population. Although mostly asymptomatic and recognized incidentally on cardiac catheterizations, they can be catastrophic and can cause sudden cardiac death. Studies have shown that right coronary artery (RCA) is the most common anomalous coronary artery. Clinical management involves percutaneous coronary intervention, however can be technically difficult in an ARCA because cannulation of the vessel may not be easy. We present the case report to highlight the use of unconventional diagnostic catheters (tiger diagnostic catheter) to perform percutaneous coronary angioplasty in a subtype C of ARCA. Seventy-four-year-old patient with a previous history of angioplasty in the left anterior descending artery presented with complaints of intermittent retrosternal chest pain for the past 2 months which was not getting relieved by medication. Anomalous origin of RCA from left coronary sinus was revealed on computed tomography angiography. After failure to hook the RCA with most guide catheters, the RCA was successfully hooked with a TIG5F (Tiger Catheter) from the right femoral artery and successful angioplasty was performed. Percutaneous transluminal coronary angioplasty with a diagnostic catheter is a viable option in patients with anomalous coronary artery origin in which other catheters fail and in cases where radiological exposure and contrast induced complications are expected.