Case 118: Manual of PCI - STEMI culprit?

A patient presented with inferolateral STEMI. A lesion was found in the LAD and successfully stented, but the right coronary artery could not be identified and engaged despite performing coronary cusp injections and a left ventriculogram. Coronary CTA revealed an anomalous coronary artery originating from the left coronary cusp close to the left main with severe lesions in the proximal and mid segment. Cardiac MRI confirmed viability and the patient was referred for PCI of the anomalous RCA. Engagement failed with an AL1 guide catheter and a guide catheter extension. Using a JL4 guide catheter the RCA could be approached and was successfully wired into the first marginal branch using a Caravel microcatheter and a Sion black guidewire. A Telescope guide extension was inserted in to the RCA to facilitate equipment delivery. The guide extension was withdrawn and a TwinPass Torque microcatheter was used to wire the distal RCA with a workhorse guidewire. After stent implantation a Grand Slam wire was inserted into the RCA followed by removal of the guide extension and IVUS examination of the RCA that demonstrated a nice final result.

Видео Case 118: Manual of PCI - STEMI culprit? канала Manos Brilakis