DOI: https://doi.org/10.36347/sjmcr.2025.v13i08.018

Pages: 1827-1830

We present the case of a 74-year-old male patient who experienced prolonged chest pain and dyspnea. During coronary angiography via the right radial approach, selective intubation of the left coronary artery (LCA) was straightforward using a Judkins Left 3.5 catheter. However, the right coronary artery (RCA) posed a significant challenge due to a high and horizontal ostial origin. Attempts using Judkins Right 4 (JR4), Amplatz Right (AR), and Amplatz Left 2 (AL2) catheters failed to achieve satisfactory engagement. A 6F GuideLiner extension catheter allowed for deep coaxial intubation and facilitated optimal contrast opacification and device delivery. This case highlights the critical role of guide extension catheters in challenging coronary anatomies.