Case 196: Manual of PCI - Calcified +aneurysmal RCA скачать в хорошем качестве

Case 196: Manual of PCI - Calcified +aneurysmal RCA

A patient was referred for PCI of a heavily calcified RCA due to medically refractory angina. He also had an aneurysm in the mid RCA. The RCA was engaged with an AL1 guide and a Trapliner. Crossing of the RCA was challenging due to difficulty advancing the wire through the aneurysm. Using a ShapeIT angulated microcatheter a Sion black wire was advanced to the distal RCA but equipment delivery was challenging and guide position was lost. The RCA was re-engaged with a 7 French 3D Right guide catheter and a Trapliner. The aneurysm was recrossed with a SuperCross 120 and after predilatation with a 1.0 mm Sapphire balloon a FineCross M3 microcatheter was advanced to the distal RCA. After rotational atherectomy of the RCA with a 1.5 mm burr, the RCA was predilated and stented. A Ringer balloon was inflated across the neck of the aneurysm facilitating delivery of 2 Concerto coils into the aneurysm using the FineCross microcatheter. A 3rd coil became prematurely detached while partially in the guide catheter. Using the “knuckle twister” technique, the dislodged coil was retrieved, followed by stenting of the proximal RCA and a nice final result. Knuckle twister technique: https://pubmed.ncbi.nlm.nih.gov/37539...