Case 100: PCI ManualI- Failing all the way to success 4

A patient with prior left main PCI and prior CABG, chronic kidney disease, and severe peripheral arterial disease presented with medically refractory angina. A decision was made to recanalize the left main, proximal LAD and proximal circumflex bifurcation and a lesion in the first obtuse marginal branch.
Access was obtained in the left common femoral artery, however the micropuncture dilator could not advance over the micropuncture wire. The micropuncture inner dilator was eventually advanced over the micropuncture wire and the micropuncture wire was exchanged for a 0.018 inch Platinum Plus wire. A new micropuncture dilator was then advanced over the Platinus Plus, followed by insertion of a 0.035 inch Amplatz super stiff guidewire and a long femoral sheath.
Right heart catheterization was performed to determine the need for hemodynamic support. The pulmonary capillary wedge pressure was 4 mmHg, hence no hemodynamic support was used. The Swan catheter twisted into a knot and could not be removed. It was re-advanced, rotated opposite to the original direction and the Platinum Plus wire was advanced through it, eventually untied the knot, allowing removal.
The OM1 lesion was stented without complications, however the left main/LAD/circumflex were balloon undilatable despite multiple high-pressure balloon inflations with standard and non-compliant balloons. Intravascular lithotripsy was performed achieving lesion expansion.
Left main dissection occurred requiring placement of a left main stent with an excellent final result and resolution of the patient’s angina.

[@matheuscsmed]

Thank you, Matheus Silva

[@shangz0216]

Thanks for sharing!

[@mohammedrady5007]

Thank you very much

[@mohammadjaber6387]

Thanks alot

[@user-su4he3ju7t]

The future is coming! This is a great case. Thank You very much!!! Is this case a first, when You use intracoronary lythotripsy?