Crossing the calcium spur with “sliding over the balloon technique” in anomalous anterior origin of right coronary artery with two right-angle bends

Abstract

We present a simple novel technique of crossing the calcium spur at right-angle bend in coronary artery by deploying a noninflated balloon over the calcium spur where the tip of the passing stent frequently hits and create difficulty in negotiation of the stent forward. When we deploy a balloon over the calcium spur, the tip of the stent does not hit the edge of the calcium spur and the stent gently slides over the hydrophilic slippery balloon forward with ease. We describe a rare case of intervention in anomalous anterior origin of right coronary artery where we were not able to pass the stent across two 90° bends which were harboring calcium spur. In spite of we adopted buddy wire and triple wire technique to make the bend straight, we were not able to move the stent forward, each time it was hitting at the edge of the calcium spur. We put a 2 mm × 10 mm noninflated semicompliant balloon each time while crossing the right-angle bend with calcium spur which covered the calcium spur and over the balloon we were easily able to slide the stent forward, deployed the stent across the lesion, and achieved distal TIMI III flow. We describe this simple novel technique of “sliding the stent over the balloon technique” to cross the calcium spur remaining at 90°-angle bend causing difficulty in forward negotiation of the stent.