PERCUTANEOUS CORONARY INTERVENTIONS

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A complicated case: Microcatheter tip fracture during LAD CTO PCI

Operators:Operator: Prof.Dr.Şevket Görgülü,
Cath Lab Nurse: Buse Taşdemir
Cath Lab Technician: İsmail Topaç

Acibadem University of Medicine, Kocaeli Acibadem Hospital

Case Summary

A 55-year-old male patient who was decided to undergo bypass surgery at the external center.  LAD CTO is present.

Procedure

The double radial approach was made with the right radial 7 Fr EBU guide catheter into the left coronary system. Image was taken (Video 1). Corsair Pro and Miracle 6 were attempted to cross the lesion (Video 2). Miracle 6 crossed the lesion, but Corsair could not pass calcification during manipulation and tip fracture occurred (Video 3). Miracle was inside the broken tip but a 1×10 balloon could not cross the lesion through the broken tip (Video 4). On this, the broken tip was tried to be crushed by the turnpike catheter. Afterwards, the Corsair tip could move with a 1×10 balloon (Video 5). Balloon pushed this part in LAD distally (Video 6). The Turnpike catheter was again sent to the distal LAD  for wire exchange and pulled back by wire trapping  (Video 7). The Miracle 6 was replaced with a soft wire and the lesion was predilated with a 2×30 mm balloon (Video 8). The 3.5×38 Xience V stent was inflated with 16 atm and waited for 30 seconds (Video 9). The post-stent status of the LAD and appearance of Corsair distal tip in a safe place (Video 10).

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Video 10

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