Successful bail-out stenting of severe stenosis of the left main trunk coronary artery using guiding catheter exchange with the anchor balloon technique

Introduction: trans radial intervention (trI) is less invasive. However, percutaneous coronary intervention (PcI) operators may be concerned that trans femoral approach (tFI) is better than trI according to the state of the patients, for example the patients with acute coronary syndrome (Acs) under the shock state, with severe winding subclavian artery and with the spasming radial artery. case report: We herein report a case of an unstable angina and acute heart failure. coronary angiography (cAG) revealed evidence of 90% ostial stenosis of the left main trunk (LMt). but we were unable to engage a 6 Fr guiding catheter (Gc) because of severe tortuosity of the left subclavian artery. therefore, we attempted intracoronary passage of a 4 Fr JL3.5 catheter exchange the 4 Fr diagnostic catheter with a 6 Fr Gc using an