Case 70: PCI Manual - Ostial and distal RCA lesion
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- čas přidán 28. 01. 2020
- A patient with ostial/proximal and distal RCA lesions was referred for PCI. Engagement caused pressure dampening requiring intermittent disengagement. The distal lesion was treated first. The distal anchor technique facilitated balloon and stent delivery, and was repeated for advancing a 2nd stent to the mid RCA. The proximal RCA was stented with slight stent protrusion into the aorta. After flaring the ostium with an Ostial Flash balloon an excellent final result was achieved as confirmed by IVUS.
- Jak na to + styl
I would like to express my deepest gratitude and sincere thanks for limitless support and informative lecture.
Thanks Dr Manos for the amazing demonstration,
We have a similar case yesterday, and we had intentionaly jailed a wire in the conal branch by stenting the ostial RCA 1st (The reverse of classic teaching) and it worked well as an anchor for equipment delivery to the distal lesion.
I want also to add a comment about using a distal stent as a platform for anchoring, this is not always free of complication (Expected to be safer than native vessel anchoring), i have a case of distal stent fracture following anchoring inside it.
Thanks alot again for your amazing fruitful video series
Excellent points, thank you. The first technique you describe (jailing a wire with a stent) is called "buddy wire stent anchor technique" and can provide strong support. Regarding distal anchoring by balloon inflation within a stent I personally have not had issues with it, but complications could still occur as you suggested.
amazing demonstration as usual thank you prof
Hi Dr Brikalis, CAn we do distal anchoring with 6 Fr Guide wire? Is there a reference size for ballons?
Hi Prof. Regarding distal anchoring with buddy wire (unstented area) --> I think we only can do it if the anchoring is done in a vessel which is intended to be stented anyway. I dont feel comfortable " POBAing" in normal vessels.
Also kit has to be 7 french guide? 2 balloons for kissing inflations in a 6F is a tight squeeze. Let alone a stent and a balloon.
Your wisdom is much appreciated Sir
Great points! Agree that it is best to not balloon coronary segments that you do not plan to stent. Distal anchoring is done with 7 or 8 French guides.
Was there loss of side branches like conus in prox. RCA in this case?
There were no major branches in this case, as far as I can tell. In general, occluing an acute marginal is unlikely to cause adverse consequences, but there have been cases of arrhythmias and/or ischemia when losing large acute marginal branches.
Sir,
A couple of months ago ı had to stent left main ostium. We had excessive overhanging (procedure was döne under CPR). After the patient recovered on the table as a solution for overhanging i bend the overhanged part toward to aortic valve snd crossed the stent from bended part and made high atmosphere balloon inflation. Have you ever had a case like that ör what would you reccomend?
I have not done this, but seems like a good solution. Would give prolonged DAPT in such cases.
@@manosbrilakis Your video presentations are much more usefull than many of cardiology congresses.
Hi Dr Brilakis. At what atmospheres do you recomend inflate balloons for distal anchoring? 4 atm?
Yes, I had the same question. Do you just go up to nominal pressure? Thank you,
It is usually high pressures - 12-20 atm. - Being inside the stent makes it usually safe.
what is the size of the balloon and to which pressure do you use when we apply side branch anchoring and distal anchoring technique? Thank you
Balloon is sized 1:1 to the side branch (usually they are small, 1.5-2.0 mm). Inflation pressure: 6-8 atm.
@@manosbrilakis I really appreciate your answer