A patient presented with inferior STEMI. Diagnostic coronary angiography done through right radial access showed multiple severe lesions in the RCA. Engagement of the RCA with an AL1 guide failed due to subclavian tortuosity. The RCA was eventually engaged using an Ikari 1.0 guide which allowed predilatation but did not provide enough support for stent delivery. The guide pressure waveform dampened due to a guide kink immediately distal to the guide hub. A 300 cm long Grand Slam wire was advanced into the RCA, followed by removal of the kinked Ikari Right 1.0 guide and insertion of an AL1 guide. After insertion of a Guideliner the proximal, mid, and distal RCA were successfully stented.
