What Role Should EBU Catheters Play in the Interventional Approach to Anomalous Right Coronary Arteries?
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Background
Percutaneous coronary intervention (PCI) for anomalous right coronary artery (ARCA) remains technically challenging due to variable ostial anatomy. The Extra Back-Up (EBU) catheter, although designed for left coronary interventions, may offer advantages in ARCA PCI, but its performance across anatomical subtypes is not well defined.
Methods
This single-center retrospective study included 17 patients (2019–2024) with ARCA from the left coronary sinus or with high take-off anatomy, in whom an EBU catheter was used. Fourteen patients underwent PCI, one had FFR-only assessment, and two underwent diagnostic angiography alone. Anatomical subtypes were: Type A (ostium above left coronary artery [LCA]), Type B (below LCA), Type C (midline), or high take-off (≥10 mm above sinotubular junction). Primary outcomes were procedural success (stable engagement, full device delivery, no catheter exchange) and safety.
Results
Procedural success with the EBU catheter was 100% in Type A (2/2) and 83.3% in Type B (5/6) when used as the initial guide. In Type C and high take-off anatomies, success was achieved in one of two cases each. EBU was also employed as a second-choice catheter in five patients after failed engagement with standard guides catheters. No catheter-related dissections occurred. One minor in-hospital complication (5.9%) and one patient had unplanned Re-intervention within 30 days.
Conclusions
EBU catheters are effective in ARCA PCI, especially in Type A and B anatomies, but less so in Type C and high take-off variants. These findings support anatomy-tailored guide selection. Multicenter studies are needed to further define role of EBU in this subset.
