Case 57: PCI Manual - Native coronary PCI via SVG

A prior CABG patient presented with NSTEMI due to a severe ostial PDA lesion, proximal to the distal anastomosis of a saphenous vein graft. Distal left radial access was used. A Trapliner was used to facilitate engagement. Retrograde wiring via the SVG was achieved using a Venture microcatheter and a Sion guidewire. Despite predilation stent delivery failed and stent became partially deformed with acute vessel closure. After changing to a Grand Slam guidewire the stent was successfully delivered and deployed.

[@ramikafa]

Really nice case and great effort! Thanks Dr. Brilakis.

[@TheNEF11]

Very educating case with a wonderful result! Thank you very much!

[@farukakturk5388]

What if you had a large perf at distal RCA? What was your plan?

[@manosbrilakis]

Coil of fat embolization (this would be a distal vessel perforation: czcams.com/video/RWsCcbmQsow/video.html)

[@farukakturk5388]

For fat embolisation instead of a micro catheter can we use work horse wire for carrying fat? If we pass inside of fat with distal end of wire can we push it with help of a balloon? Do you have an experience like this?

[@manosbrilakis]

You must use a microcatheter to deliver the fat to the perforation site. Advancing fat on a wire alone could result in systemic or coronary embolization.