“Over The Shoulder” Guidewire Manipulation Through An Angulated Stenosis Adjacent To A Coronary Aneurysm During High Risk Percutaneous Transluminal Angioplasty

Angioplasty in the setting of poor left ventricular function may involve coronary anatomy with special challenges to the technique of the operator and the safety of the patient. Spontaneous coronary aneurysms involve a disruption of the tissue of the vessel and the linear geometry of the lumen. This case reports the dilatation of a stenosis traversing a large spontaneous aneurysm in a patient with severe left ventricular dysfunction. Using a novel guidewire technique to traverse the lesion and a perfusion balloon catheter to slowly dilate it, an excellent angiographic and clinical result was achieved. (J Interven Cardiol 1992; 5:232–330)