Case 143: PCI Manual - A great start!! скачать в хорошем качестве

Case 143: PCI Manual - A great start!!

A patient with a HeartMate ventricular assist device presented with multiple ICD shocks and was referred or coronary angiography. Pressure waveform was flat (patient on VAD with non-pulsatile arterial waveform). The initial injection of the left main caused a left main dissection, propagating towards to the aorta (aortocoronary dissection) and air embolization. The patient remained hemodynamically stable. The right coronary artery did not have any significant lesions. A guide was inserted to engage the left main but no aspiration could be performed. The guide was removed and then flushed (outside the body) retrieving several large thrombi. The left main was re-engaged and the LAD and circumflex wire using workhorse guidewires. The LAD was heavily calcified and was treated with multiple rounds of orbital atherectomy. This resulted in good flow in the LAD. Kissing balloon inflation was done (left main into LAD and left main into circumflex) with nice result, but flow in the mid circumflex ceased, likely due to dissection. Attempts to enter into the distal true lumen failed, but the patient remained stable and recanalization attempts of the circumflex were aborted.