A young patient with diabetes presented with progressive angina. Diagnostic angiography showed 2-vessel cad with severe lesions in the proximal and mid right coronary artery and the second obtuse marginal branch. After discussion with the patient and the referring physician a decision was made to proceed with PCI, starting with the 2nd OM lesion. The lesion was balloon uncrossable despite using a 1.0 mm Sapphire Pro balloon. Using a Telescope guide catheter extension the lesion was crossed with a 2.0 mm balloon that had a waist and subsequently ruptured, causing a dissection. Additional balloons could not be delivered after the rupture and attempts to wire with a Viperwire Flex tip failed. A Turnpike LP was advanced distally but became “frozen” and had to be removed together with the guidewire. The lesion was rewired using a Viperwire Flex tip followed by several rounds of orbital atherectomy. Unfortunately, the lesion remained undilatable despite multiple additional balloons inflations. A decision was made to stop the procedure given radiation dose and re-examine treatment options (PCI of RCA only, re-attempt of OM2 PCI with laser/rotational atherectomy, or CABG).
- Күн бұрын
Case 99: PCI Manual - Balloon uncrossable and undilatable lesion
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