Case 40: Manual of non-CTO coronary interventions: When everything goes wrong

A patient presented with inferior STEMI and was found to have severe lesions in the mid and distal RCA. Engagement of the RCA via right radial access was challenging resulting in acute vessel closure. Attempts to re-enter the true lumen failed, in part due to poor guide catheter support. Attempts to get access in the right femoral artery also failed, as the wire could not be advanced past the iliac artery due to calcification, tortuosity, and an iliac aneurysm. Left femoral access was obtained with repeat attempts to recanalize the RCA. The patient developed hypotension and pelvic fluorosopy revealed a displaced bladder, suggesting a retroperitoneal hematoma. A balloon was inflated in the right iliac artery but a covered stent could not be delivered. The patient developed ventricular fibrillation, requiring multiple defibrillations and eventually placement of VA ECMO (surgically in the right common femoral vein and percutaneously in the left common femoral artery). The RCA was subsequently recanalized using a knuckle to cross subintimally distal to the previously placed stents and a Stingray to re-enter into the distal true lumen. The patient had a prolonged hospital course but eventually recovered.

Видео Case 40: Manual of non-CTO coronary interventions: When everything goes wrong канала Manos Brilakis