{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T18:58:47Z","timestamp":1767121127792,"version":"3.48.0"},"reference-count":16,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T00:00:00Z","timestamp":1767052800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Background<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This single-center retrospective case series included 17 patients (2019\u20132024) 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 fractional flow reserve (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 (\u226510 mm above sinotubular junction). Primary outcomes were procedural success (stable engagement, full device delivery, no catheter exchange) and safety.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n 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(one Type A, three Type B, one high take-off) after failed engagement with standard guides catheters. No catheter-related dissections occurred. One minor in-hospital complication (5.9%) and one patient required unplanned re-intervention within 30 days.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n In this descriptive series, the EBU catheter was successfully employed as a primary or rescue tool in a majority of select ARCA cases, with the highest success in Types A and B. These observations, while not comparative, suggest it is a viable option in the operator\u2019s arsenal for these challenging anatomies and warrant further prospective evaluation.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0326548","type":"journal-article","created":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T18:55:37Z","timestamp":1767120937000},"page":"e0326548","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["What role should EBU catheters play in the interventional approach to anomalous right coronary arteries? A case series"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-1838-7981","authenticated-orcid":true,"given":"Mikias Legesse","family":"Gebremedhin","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Milan","family":"Sigdel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhao","family":"Ruixue","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"BinBin","family":"Du","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yanzhou","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,12,30]]},"reference":[{"issue":"6","key":"pone.0326548.ref001","doi-asserted-by":"crossref","first-page":"339","DOI":"10.11622\/smedj.2014193","article-title":"Coronary anatomy, anatomic variations and anomalies: a retrospective coronary angiography study","volume":"56","author":"C Altin","year":"2015","journal-title":"Singapore Med J"},{"issue":"6","key":"pone.0326548.ref002","doi-asserted-by":"crossref","first-page":"537","DOI":"10.4329\/wjr.v8.i6.537","article-title":"Coronary artery anomalies overview: the normal and the abnormal","volume":"8","author":"AD Villa","year":"2016","journal-title":"World J Radiol"},{"issue":"1","key":"pone.0326548.ref003","first-page":"28","article-title":"Coronary artery anomalies in 126,595 patients undergoing coronary arteriography","volume":"21","author":"O Yamanaka","year":"1990","journal-title":"Cathet Cardiovasc Diagn"},{"issue":"4","key":"pone.0326548.ref004","article-title":"Prevalence and pattern of congenital coronary artery anomalies in patients undergoing coronary angiography at a tertiary care hospital of Northern India","volume":"13","author":"JR Kashyap","year":"2021","journal-title":"Cureus"},{"key":"pone.0326548.ref005","article-title":"Prevalence and characters of anomalous coronary artery from coronary magnetic resonance angiography","author":"R Krittayaphong","year":"2014","journal-title":"J Med Assoc Thai"},{"issue":"1","key":"pone.0326548.ref006","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1007\/s10554-014-0535-4","article-title":"Anatomic characteristics and outcome of adults with coronary arteries arising from an anomalous location detected with coronary computed tomography angiography","volume":"31","author":"A Nasis","year":"2015","journal-title":"Int J Cardiovasc Imaging"},{"issue":"4","key":"pone.0326548.ref007","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1016\/j.ihj.2014.05.029","article-title":"Coronary intervention in anomalous origin of the right coronary artery (ARCA) from the left sinus of valsalva (LSOV): a single center experience","volume":"66","author":"K Uthayakumaran","year":"2014","journal-title":"Indian Heart J"},{"issue":"3","key":"pone.0326548.ref008","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1016\/0735-1097(92)90019-J","article-title":"Sudden cardiac death associated with isolated congenital coronary artery anomalies","volume":"20","author":"AJ Taylor","year":"1992","journal-title":"J Am Coll Cardiol"},{"issue":"3","key":"pone.0326548.ref009","doi-asserted-by":"crossref","first-page":"1554","DOI":"10.3390\/ijerph19031554","article-title":"Sudden cardiac arrest in an adult with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA): case report","volume":"19","author":"FR Prandi","year":"2022","journal-title":"Int J Environ Res Public Health"},{"issue":"3","key":"pone.0326548.ref010","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1111\/j.1540-8183.2009.00463.x","article-title":"Catheter selection for coronary angiography and intervention in anomalous right coronary arteries","volume":"22","author":"K Sarkar","year":"2009","journal-title":"J Interv Cardiol"},{"issue":"3","key":"pone.0326548.ref011","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1002\/ca.22664","article-title":"The clinical anatomy of high take-off coronary arteries","volume":"29","author":"M Loukas","year":"2016","journal-title":"Clin Anat"},{"key":"pone.0326548.ref012","unstructured":"Cook J. 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