Case 188: Manual of CTO PCI - I blew it! скачать в хорошем качестве

Case 188: Manual of CTO PCI - I blew it!

A prior CABG patient was referred for PCI of a right coronary artery CTO for medically refractory angina. He had a SVG to the PDA that had been stented in the past, both proximally and across the distal anastomosis, and was now occluded. The CTO had an ambiguous proximal cap, ipsilateral epicardial collaterals, possible septal collaterals and heavy calcification. An initial crossing attempt was done with antegrade wiring with a Fielder XT-A and although the wire seemed to “dance” with the vessel, crossing failed. Retrograde crossing attempts through septal collaterals and the occluded SVG-PDA also failed. Repeat angiography of the RCA showed a perforation, likely wire-induced. Fortunately the perforation sealed without need for coiling of covered stent. Protamine was reversed. Echo did not show a pericardial effusion. The patient had an uneventful recovery.