26.2 Manual of PCI - Large vessel perforation

Step-by-step description of how to treat large vessel coronary perforations - options include:
1. Prolonged balloon inflation
2. Covered stent implantation (through a single guide catheter using the block+deliver technique or 2 guides using the ping pong guide technique)
3. Dissection techniques
4. Surgery

[@saeedalam4608]

Hi Monis!
I have learnt a technique from Dr muramatsu in Japan, that after large vessel perforation, a microcatheter is advanced over a second guide wire and then this microcatheter is trapped by an inflated balloon and then blood is slowly injected via this microcatheter while the balloon is inflated preventing ischemic injury with prolonged balloon inflation

[@manosbrilakis]

Excellent point, thank you!

[@shangz0216]

Thanks for your educative presentation.

[@Nikesnipe]

Thank you so much! Milad From Germany cardiology

[@micger]

If you leave the balloon perforation for 3 hours, the ACT drops to very low levels. Did you give heparin? If not then wouldn't you be worried about thrombus?

[@manosbrilakis]

If the balloon is inflated the patient should be anticoagulated, so yes, more heparin would be needed to prevent thrombosis.

[@albertjang6945]

wow, scary. I would lose my poise in these situations.