Sccessful coronary intervention combinig common guiding catheter in long guiding sheath

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A case was 57-year old man with hemodialysis, distal abdominal aorta obstruction, post right axilla bi-femoral bypasssurgery and left forearm shunts construction. Catheter approach to the coronary arteries was limited. It was able to beapproached only from the right arm's brachial artery, but the high tortuousness and the high calcification wereobserved from the subclavian artery to the brachiocephalic trunk. Although the chronic total occlusion of rightcoronary artery and the left main trunk stenosis were observed by the coronary angiography, revascularized it by thepercutaneous coronary intervension (PCI). He was deemed a high-risk surgical candidate and underwent PCI withright transbrachial approach. Because of the high calcification, the anatomical characteristics, etc., operating theguiding catheter was hard. We experienced the case in which the PCI in an easy way had become possible by using along guiding sheath. For the patients with a limited artery approach, mechanical cardiac supports such as intra-aorticballoon pumping or percutaneous cardio-pulmonary support are not available, and a deft and safe procedure isrequired. For such cases, it is thought that use of a long guiding sheath is useful, expecting the operability, theapproachability, and the kink-resistant character.