Coronary angioplasty of a posterolateral branch with severe proximal vessel tortuosity

We present a case of a patient who experienced recurrent angina 15 months after coronary bypass surgery. A single lesion distal to a graft anastomosis was identified in the posterolateral coronary artery. There were two severe angulations, each greater than 90° proximal to the lesion, with access possible only through the saphenous vein graft to the posterior descending artery. For ultimate success, such challenging anatomy required a combination of an array of guidewires, secondary support catheters, and a deflecting balloon. Cathet. Cardiovasc. Diagn. 41:426–429, 1997. © 1997 Wiley-Liss, Inc.