Case 15: PCI Manual - Balloon undilatable
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- čas přidán 7. 09. 2024
- Challenging case of balloon undilatable right coronary artery lesion in patient who has had prior coronary bypass graft surgery. Wiring was challenging but was achieved using a microcatheter to support the wire. The lesion could not be dilated despite using high-pressure balloon inflations even with a buddy wire, but expanded with the Angiosculpt balloon. Stent delivery failed even through a guide catheter extension, but was sucessfully completed using the distal anchor technique. This case illustrates that challenges can be encountered at every step of a PCI procedure, but can be overcome but using a variety of equipment and techniques.
interesting!
Are you not worried about intimal injury with balloon in non stented area downstream?
Great point: we usually try to inflate the balloon within the segment that will be stented in the end, as quite often the last few millimeters are easier to cross with the stent. If the distal anchor balloon needs to be inflated in an area that will not be stented, we try to use low pressures (4-6 atm). Have not had a case of dissection or restenosis, but this is one of the potential risks of this technique.
Are you able to deliver 2 coronary wires, 1 stent and 1 balloon through a 6 Fr guideliner when doing distal anchoring technique?
I have used a 6 Fr GL, 2 wires to deliver a stent, but I have not tried using a balloon and stent through a guideliner. Thanks!
No you are not. The best resource about what you can fit in a guide is this app: www.complexpcisolutions.com/
Can we worrie to performe stent deformation, when we remove anchoring balloon, in situations, when we use distal anchoring technique? Thank you
Stent deformation can happen during removal of any balloon, including achoring balloon, if balloon removal cause the guide to be "sucked into" the vessel.