AMAC: Anchor the Mother to Advance the Child – a technique for complex PCI

Several algorithms have been proposed to address the issue of uncrossability and impenetrability; however, these challenges remain a significant cause of failure in percutaneous coronary intervention (PCI) procedures1234.

We describe an alternative technique to enhance support and penetration safely and efficiently: the Anchor the Mother to Advance the Child (AMAC) technique. This approach successfully facilitated a multiattempt, complex coronary total occlusion (CTO) PCI, where all other options had failed.

A 58-year-old male with a long-standing, calcific CTO of the right coronary artery (Figure 1A, Moving image 1) was admitted to our hospital due to unresponsive angina despite medical therapy. The CTO had been previously documented, and the patient had undergone three unsuccessful treatment attempts by experienced operators. These attempts failed because the midsection of the occlusion was uncrossable, and the distal part was impenetrable (Supplementary Figure 1). After a collegial discussion, we decided to make one final attempt at treatment.

The right coronary artery was engaged using an 8 French (Fr) Amplatz Left (AL) 1 catheter through the right femoral artery. At the...