Case 95: PCI Manual - STEMI and unable to engage

A patient presented with inferior ST-segment elevation acute myocardial infarction. The left main was initially injected showing lesions in the LAD and circumflex. The RCA could not be engaged with a JR4 catheter. Cusp angiogram showed some filling of the RCA but the ostium could not be localized. Eventually the RCA was engaged with a multipurpose catheter: it had a superior and inferiorly directed take-off. Balloon angioplasty, followed by aspiration thrombectomy and stenting were performed with an excellent final result.