Case 133: Manual of PCI - SVG perforation скачать в хорошем качестве

Case 133: Manual of PCI - SVG perforation

A patient with prior CABG presented with NSTEMI. He was on warfarin with INR of 2.2. Diagnostic coronary angiography performed via radial access showed a severe lesion in the body of a SVG to the first obtuse marginal branch. Stenting of the lesion was complicated by SVG perforation. We re-inflated the stent balloon to achieve hemostasis. We obtained femoral access and engaged the SVG with an 8 French AL1 guide catheter after withdrawing the first guide catheter (ping-pong guide catheter technique). The goal was to deliver a covered stent to seal the perforation. We wired the SVG through the 8 French guide catheter with a workhorse guidewire, removed the stent balloon and inflated a blocking balloon through the 8 French guide catheter. We attempted to deliver the Filterwire retrieval catheter but could not advance it all the way to the filter. The filter was pulled back resulting in interlocking of the two guide catheters, likely because the filter “caught” the workhorse guidewire. Eventually with forceful pulling the two guide catheters were separated and the guidewires retrieved, severely deformed. The SVG was re-engaged with the 8 French AL1 guide catheter and a Papyrus covered stent was deployed sealing the perforation. This is why buddy wires should NOT be used together with filters!