NHancer Rx Dual Lumen Rx Microcatheter Complex PCI | Brian Bergmark, MD

Regaining Access in a Dissected Bifurcation: Complex Distal RCA PCI with the NHancer Rx™ Dual Lumen RX Microcatheter Dr Brian Bergmark, MD, Interventional Cardiologist in the Complex Coronary/CTO Program at Brigham and Women's Hospital, Harvard Medical School, and Investigator with the TIMI Study Group, walks through a complex calcified distal right coronary artery (RCA) bifurcation case in which the NHancer Rx™ dual lumen RX microcatheter from IMDS enabled repeat access after a bifurcation dissection. ▶ THE CASE 79-year-old man with angina. Angiography showed a tortuous RCA with a calcified distal lesion at the PDA/PLV bifurcation. The case was performed through a 7F AR1 guide. ▶ THE PROCEDURE After wiring with a workhorse wire, a 2.5 mm non-compliant balloon at high pressure left persistent underexpansion. An intravascular lithotripsy (IVL) balloon then ruptured at 4 atm, and contrast tracked into the PLV, causing a dissection at the bifurcation and a corkscrew appearance of the distal RCA. The NHancer Rx dual lumen microcatheter crossed into the PDA. A second wire introduced through it confirmed true-lumen position in the PDA and was then redirected into the PLV. The PLV lesion could not be crossed by a balloon, a Takeru™ balloon or a single lumen microcatheter, so rotational atherectomy was performed on a RotaWire™ with a 1.5 mm burr and GuideLiner® support. The burr was preloaded into the GuideLiner outside the body, led through the guide first, and the GuideLiner was then advanced over it. The NHancer Rx was then re-advanced on the PLV wire to rewire the bifurcation, with a workhorse wire placed back into the PDA. A distal perforation caused by the RotaWire was treated with coils to the distal PLV, with all other wiring confirmed intraluminal. ▶ THE RESULT Distal PLV branch coiled, drug-coated balloon to the ostial PLV, and a stent to the PDA. ▶ WHY NHANCER RX ✔ Dual lumen design combining a rapid exchange (RX) lumen with an over-the-wire (OTW) lumen ✔ Allows a second wire to be introduced while keeping access to the first ✔ Helps confirm true-lumen position and redirect wires at a bifurcation ✔ Enables repeat access to a dissected bifurcation ✔ Exit markers at 95 cm and 105 cm and a removable stylet ▶ SPECIFICATIONS Model: NRX1413518 Guidewire compatibility, OTW lumen: 0.014" Guidewire compatibility, RX lumen: 0.014" Usable length: 135 cm Shaft inner diameter: 0.48 mm Hydrophilic coating and radiopaque atraumatic tip ▶ CHAPTERS 0:00 Introduction 0:16 Product specifications 0:27 Case presentation 1:15 Non-compliant balloon predilation 1:42 IVL balloon rupture 2:00 Dissection at the bifurcation 2:33 NHancer Rx crosses into the PDA 2:42 Second wire via the dual lumen microcatheter 3:02 Uncrossable PLV lesion 3:54 Rotational atherectomy with GuideLiner support 4:31 Rewiring the bifurcation with NHancer Rx 4:54 Distal perforation and management 5:46 Final result 6:06 Conclusions IMDS: Simplify Everyday PCI Complexity #ComplexPCI #InterventionalCardiology #NHancerRx #IMDS #PCI #RCA #Microcatheter #DualLumenMicrocatheter #BifurcationPCI #RotationalAtherectomy #IVL #CoronaryDissection #Cardiology #CathLab #CoronaryIntervention This video was produced and is intended as an educational tool and not as a supplement to existing labeling and training materials. Please see the Instructions for Use for a complete listing of the indications, contraindications, warnings and precautions. Caution: Federal law (U.S.) restricts this device to sale by or on the order of a physician. © 2026 IMDS (Interventional Medical Device Solutions). NHancer Rx™ is a trademark of IMDS.