What Role Should EBU Catheters Play in the Interventional Approach to Anomalous Right Coronary Arteries?

Abstract 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.