PERCUTANEOUS CORONARY INTERVENTIONS

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Complex PCI for Tortuous LCX-OM Stenoses

Operators:Prof.Dr.Bilal Boztosun
Dr.H.Murat Güneş
Dr.Ersin İbişoğlu

İstanbul Medipol University Hospital Cardiology Department

Case Summary

A 70-year-old female patient admitted to our clinic because of effort chest pain. She had been previously tried twice percutaneous intervention in CX-OM1 and OM2 with the same complaints but failed and then directed to our hospital.

Procedure

A 6F sheath was placed in the left radial artery. Then the EBU 3,5 guiding catheter was placed in the left main coronary. Image received (Video 01). LCX OM1 lesion was crossed with whisper extra support guidewire (Video 02). 16 atm dilatation was made with the 1.5 x 12 mm mini trek ptca balloon (Video 03). Then the 2.5×15 mm ryujin plus ptca balloon was tried to advance but did not cross the lesion. After that, 2.0 × 12 mm ryujin plus ptca baloon was advanced and dilated at 16 atm (Video 04). It was tried again with 2.5 x 15 mm ryujin plus ptca balloon but failed (Video 05). Because it can not be advanced, anchoring with 2.0 × 12 mm ryujin plus ptca balloon 6F guideliner was advanced (Video 06). With the guideliner the 2.5×15 mm ryujin plus ptca balloon was advanced and the lesion was dilated at 18 atm (Video 07). First 2.5 x 28 mm xience pro des then 2.5 x 18 mm onyx des can not be advanced (Video 08).  Due to failure of advancing stents the system was retracted. Then the lesion area was crossed with PT2 guidewire via corsair microcatheter (Video 09). Grand slam guidewire with extension was exchanged with PT2 guidewire in CORSAIR microcatheter Video 10). 6F GUIDELINER was again approached to the lesion with anchoring of 2.5 × 15 mm ryujin plus ptca balloon (Video 11). Over the guideliner 2.5 x 26 mm orsiro des was implated with 16 atm (Video 12). Postdilated at 18 atm with a 3.0 x 9 mm simpass nc balloon (Video 13). A self-limiting coronary rupture was observed in distal OM1 (Video 14). The patient’s hemodynamics were stable and no significant effusion was observed on the transthoracic echocardiography and therefore it was not intervened.

CX-OM2 was crossed with guidewire. It was predilated with 2.5 x 15 mm RYUJIN PLUS PTCA balloon (Video 15). 2.5 x 28 mm xience pro des was implanted at 18 atm (Video 16). Then postdilated at 18 atm with 3.0 x 9 mm simpass nc balloon (Video 17). Full clarity was provided (Video 18).

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