Case 118: Manual of CTO Interventions: alternative treatment of large vessel perforation

Attempts to cross a right coronary artery CTO with blunt proximal cap resulted in perforation due to guidewire and microcatheter exit. The microcatheter was removed resulting in pericardial bleeding. A balloon was inflated proximal to the perforation achieving hemostasis. We then crossed retrograde via an epicardial collateral, but lost wire and guide position due to poor guide catheter support. Femoral access was obtained and the left main was engaged with an 8 French EBU 3.5 guide catheter that provided better support. The CTO was crossed retrogradely using the reverse CART technque that resulted in sealing of the mid RCA perforation. Aortocoronary dissection also occurred and was treated by stopping antegrade injection and covering the ostium with a short drug-eluting stent, followed by postdilation with an Ostial Flash balloon.

Видео Case 118: Manual of CTO Interventions: alternative treatment of large vessel perforation канала Manos Brilakis