Guide Extension-Facilitated Ostial Stenting (GEST) During Primary Coronary Angioplasty in a Patient With ST-Segment Elevation Myocardial Infarction: A Case Report

The guide extension-facilitated ostial stenting (GEST) technique uses a guide extension catheter (GEC) to improve stent delivery during primary coronary angioplasty (PCI). GECs are used for stent delivery into the coronary arteries of patients with difficult anatomy due to tortuosity, calcification, or chronic total occlusion (CTO) vessels. Stent and balloon placement has become challenging in patients with increasing lesion complexity due to tortuosity, vessel morphology, length of the lesion, and respiratory movements. To overcome this challenge, a guide catheter can be useful support enabling the deployment of stents in such challenging cases. We present the case of a 56-year-old male patient who was brought in by an ambulance with out-of-hospital ventricular fibrillation arrest (OOHVFA) and return of spontaneous circulation (ROSC) following successful resuscitation. The patient underwent emergency coronary angioplasty, which revealed extensive disease in the left coronary arteries and severe disease in the right coronary artery (RCA). Coronary angioplasty proved challenging secondary to vessel tortuosity, and a GEC was used for stent placement. Two stents were placed into the RCA in an overlapping fashion with the help of GEC to achieve thrombolysis in myocardial infarction (TIMI-3) flow. The patient was admitted to the intensive care unit (ICU), and echocardiography revealed mild-to-moderate left ventricular systolic dysfunction. The patient required significant inotropic support, and a computerised tomography (CT) scan of the brain showed severe hypoxic encephalopathy. The patient did not show any improvement and remained under intubation. The patient was extubated following a discussion with his family and palliative care team and passed away peacefully.