Case 71: PCI Manual - Serial troubleshooting
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- čas přidán 2. 02. 2020
- A patient with heavy coronary calcification on coronary CT angiography underwent coronary angiography showing several ostial and mid/distal right coronary artery lesions, ostial ramus and diffuse LAD disease. Physiologic assessment showed that the LAD and ramus were not significant hence PCI of the RCA was undertaken.
Balloon angioplasty of the ostial lesion was performed to minimize dampening followed by insertion of a 7 French Telescope for facilitating delivery. Advancement of a 4x40 mm DES through the collar of the guide extension was challenging resulting in stent loss. A 1.5 mm balloon was advanced through the lost stent, inflated and withdrawn together with the lost stent (small balloon technique). Additional predilation was done. The distal anchor technique failed to deliver a stent, but deep engagement of the guide extension using the inch-worming technique was successful with an excellent final result. - Jak na to + styl
In my practice I often use Orsiro stent. And I have not any problems with delivery. Coronary Stents with thin struts cost more, but if we add cost of guide extensors+baloons+contrast+and time of procedure...cost of Stents with thick struts looks not cheap. I mean case like You had been presented. Thank You very much, professor!
Excellent case, very didactic and with an impeccable standardization sequence
Excelent presentation. Thank you very much. I am looking forward new ones.
Was there a reason why an AL guide was not used? Thank you for this excellent video.
I usually avoid AL guides for ostial RCA lesions as it is hard to disengage and re-engage, often resulting in guide and wire position loss.
Understood. Thanks much for the reply.
Quick question: although Ramus dPR was within normal range even though visually ostial Ramus looks significant. How to predict instability of such lesions?
How to make sure that i might not face a NSTEMI or a STEMI? Many thanks in advance.