Angioplasty of unusually large coronary arteries using the hugging balloon technique via a single guiding catheter

Abstract

Unusually large native coronary arteries, in particular those supplying expansive regions of myocardium, may not be adequately dilated using currently available coronary angioplasty catheters. The "hugging balloon" technique, in which two dilatation catheter balloons are simultaneously inflated side-by-side, has been previously described for lesions in large saphenous vein grafts using the double guiding catheter (and dual entry site) technique. With the development of large lumen guiding catheters and lower profile dilatation catheters, we report the initial use of the hugging balloon technique via a single guiding catheter in oversized native coronary arteries.

“Hugging balloon” dilatation: Modification and limitation of the technique in oversized vessels

“…The first application of "hugging balloon" dilatation was reported by Teirstein et al [1] with two guiding catheters via two separate femoral punctures through which two dilatation catheters were introduced to dilate an oversize graft. This technique has been modified by others with the use of a single 9F guiding catheter and a combination of one "over-the-wire" and one "ona-wire"catheter and more recently two "balloon-on-awire" catheters through a Standard 8F guide [2][3][4]. The use of a single balloon catheter designed for peripheral arteries to dilate a vein graft has also been described, but this technique requires the need of a stiffer guiding wire (0.035/1) and the withdrawal of the guiding catheter before dilatation [7].…”

“…The lllltIal technique necessitated two balloon dilatation catheters in two separate guiding catheters via two different arteriotomies [1]. With the advent of lower profile catheter and larger 9F guiding catheter, however, it is possible to introduce simultaneously two dilatation catheters, a conventional "over the wire" and a balloon "on a wire," in a single 9F guiding catheter [2,3]. More recently, the use of two balloon "on-a-wire" systems in a Standard 8F guiding catheter has been proposed [4].…”

Angioplasty of a large aortocoronary bypass graft utilizing a single oversized balloon catheter

“…Attempts to obtain an optimal balloon-vessel ratio have included simultaneous inflation of two balloons [1,2] and the use of a peripheral angioplasty balloon [3,4]. In this report, we describe the use of an over-the-wire 5 mm balloon through a standard 8F guiding catheter to dilate a large saphenous vein graft to the left anterior descending coronary artery.…”

Hugging balloon coronary angioplasty of a large left circumflex coronary artery

“…Recently clinicians have performed hugging balloon angioplasty in saphenous vein grafts [l] and native coronary arteries [2] when the vessel diameter exceeds that of the commonly manufactured dilatation balloons. The balloon to vessel ratio is probably the single most important criteria in selecting balloon sizes; consequently, in hugging balloon angioplasty, the diameter of the dual balloon configuration is not simply the sum of the diameters of the individual balloons.…”