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We describe a case where extreme tortuosity in the patient's iliac arterial system precluded the manipulation and therefore engagement of 8 Fr guiding catheters with our target vessel. After diagnostic coronary angiography was performed with 6 Fr catheters, successful balloon angioplasty was negotiated over a stiff guidewire without guiding catheter support. Balloon dilatation of the ostial stenosis enabled subsequent engagement with 8 Fr guiding catheter and successful stent delivery.
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