ABSTRACT
Conventionally, during a primary percutaneous coronary intervention (PPCI), a diagnostic catheter is used to visualize the contralateral coronary system from the site of the acute occlusion. For that purpose, Judkins Right 4 (JR4) or Judkins Left 3.5 (JL3.5) diagnostic catheters are usually preferred, depending on the ECG findings. On the other hand, the use of a dedicated diagnostic catheter in the setting of PPCI is supported only by evidence extrapolated from coronary angiography on patients with stable coronary artery disease. We present a case of a 46-year-old patient who presented with ST-segment elevation myocardial infarction (STEMI) and underwent successful PPCI. A 6-French (Fr) radial sheath was placed in the right radial artery. Due to the presence of ST-segment elevation in both the inferior as well as in the anterior precordial leads, raising the possibility of a wrap-around left anterior descending (LAD) artery as the infarct-related artery, a 5-Fr Tiger (TIG) diagnostic catheter was initially used for cannulation of the left coronary system. The culprit lesion was identified in the proximal part of a small second right ventricular (RV) branch where it was 100% occluded with thrombus and the patient had a successful PPCI.
