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6-French sheath was placed into the right femoral artery via the modified Seldinger technique. Once the sheath was in place, the patient was given an Angiomax bolus and started on an Angiomax drip. An XB 4.0 guiding catheter was then advanced over the long guidewire and used to selectively engage the left main coronary artery. We then attempted to pass An Asahi Prowater interventional guidewire into the distal circumflex. We started having issues passing the wire distally around the midcircumflex, however, due to heavy calcification and tortuosity in the proximal and mid vessel. With some difficulty, we were able to get the wire at least beyond the ostial, proximal, and mid circumflex lesions. We were unable to pass it into the very distal vasculature. We then attempted to take the Assist FFR catheter into the circumflex to document hemodynamic significance of the stenoses, as his nuclear stress test in February was unremarkable. The FFR catheter was able to be passed with significant difficulty into the mid circumflex. FFR at that point was 0.97 after 3 minutes of adenosine. At that point, we did not feel that the approachable lesions were of significant hemodynamic significance to proceed with any further interventional therapy, so the FFR catheter and the guidewire were removed. The guide was removed over a long guidewire. This was replaced with an XB RCA with side holes guide, which was then used to selectively engage the ostium of the right coronary artery. I was going to attempt to at least see how easily the wire passed into this heavily calcified and complicated right coronary artery. We advanced the aforementioned Asahi Prowater interventional guidewire beyond the proximal and mid right coronary stenoses, but again, when the tip got into the mid to distal vasculature, the more proximal portions of the wire started binding on the calcification and tortuosity in the proximal right coronary system. The wire was not able to be advanced into the distal RCA or RPDA due to the calcification. At this point, I wanted to see if the FFR catheter, which is a roughly the equivalent size of the balloon, would even pass beyond the proximal RCA. We were unable to advance the FFR catheter beyond the proximal RCA lesion due to the blockage and heavy calcification. At this point, I did not feel comfortable proceeding with any further interventional therapy on the right coronary artery without a more supportive guide and a larger guiding system. We removed the FFR catheter and guidewire, as well as the interventional guide, and the procedure was ultimately terminated. A nonselective right femoral arteriogram performed revealed arteriotomy placement of the proximal SFA. The patient was transferred back to the holding area and manual pressure hemostasis will be obtained.:):)

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