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Cardiovasc Interv Ther. 2013 Apr;28(2):213-5. doi: 10.1007/s12928-012-0149-5. Epub 2012 Dec 1.

Percutaneous coronary intervention without use of guiding catheters for extreme downsizing: the Emperor's new clothes technique.

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Department of Cardiology, Aomori Prefectural Central Hospital, 2-1-1 Higashi-Tsukurimichi, Aomori City 030-8553, Japan.


A 72-year-old male with effort angina pectoris and old myocardial infarction underwent percutaneous coronary intervention (PCI). A 4 Fr sheath was inserted in the radial artery. After diagnostic angiography, a guidewire was inserted from the diagnostic catheter. The diagnostic catheter is removed, and the distal tip of the guidewire remains in the coronary artery. Intravascular ultrasound (IVUS) could be performed via the 4 Fr sheath without guiding catheters. IVUS-guide PCI was successfully performed with 4 Fr sheath, although IVUS requires at least a 5 Fr or larger system. This technique is called "The Emperor's New Clothes Technique" because PCI is performed as if an invisible guiding catheter was being used.

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