Case 76 - Manual of PCI - Wiring challenges

A patient was referred for PCI of a highly tortuous right coronary artery after turning down CABG. He also had a CTO of the mid LAD. Engagement of the RCA was challenging. Using a short femoral sheath and an AL1 guide failed. A JR4 guide successfully engaged the right coronary artery but provided poor support and guide position was lost during attempts to advance a 6 French Trapliner.
The femoral sheath was changed to a 45 cm long sheath that improved handling of the guide catheter. Delivery of the Trapliner was initially successful using the inch-worming technique, but its position was subsequently lost. Using the side branch anchor technique with a 2.0 mm balloon in a large acute marginal branch allowed delivery of a Caravel microcatheter to the mid RCA proximal to the target lesion. Despite using multiple guidewires (Sion, Fielder FC, Sion black, Suoh 03, Pilot 200, Gladius Mongo) the target lesion could not be crossed. Because of concerns for hemodynamic compromise if the RCA flow was disrupted (due to the LAD CTO) the procedure was stopped and the patient was encouraged to reconsider CABG.

Видео Case 76 - Manual of PCI - Wiring challenges канала Manos Brilakis