No PCI is easy: PCI in a patient who suffered CIN before!

Operators:Assoc. Prof. Dr. Mutlu Vural

Bağcılar Education and Research Hospital

Case Report

A 56-year-old male patient developed CIN after he has undergone coronary angiography at another center . In the report, there has been declared critical lesions in D1, RCA and OM (proposed PCI). Creatinine was 1.37 and CC was 56 ml / min. He has very serious symptoms that disrupt the quality of life. FC was 4 METs nearby. Risks to the patient were explained and the patient was admitted one day  for isotonic i.v. prior to PCI. decided that the RCA stenosis was not critical (Video 1 and Video 2) and the medical treatment of D1 (Video 3). Only the OM procedure was planned (Video 4). It is planned to start with AL-2 guiding catheter and floppy wire and make a PCIusing limited opaque material such as 30 ml.

Intervention Description

During the procedure it was seen that the guidewire did not pass to OM and dropped to the LCX when there was the smallest resistance (Video 5). When the angle was increased and the re-wiring was performed, it was observed that a small side branch was passed or in the subintimal area immediately after the stenosis was crossed (Video 6). With a very gentle maneuver, the wire was retracted and guided, but not overly convoluted distal to the main lumen (Video 7). The possibility of a false lumen was not also excluded. Later on, the knuckle was occurred. Predilatation was done with a small balloon. After receiving the image (Video 8)  a 2.75×30 mm DES was implanted (12-16 atm)  because of the long length of lesion. However, a 3.0×13 mm NC balloon was taken due to stent underexpansion ( Resim 1).  Surprisingly, the distal noncritical area was severely resisted and the residual stenosis was left ( Resim 2). After proximal and distally re-applied higher pressure NC balloon, such as 20-24 atm, the final angiography was satisfactory (Video 9). Despite being targeted at 30 cc in this case, a total of 70 cc opaque was used (2/3 was used during wiring attempts).

Video 1

Video 2

Video 3

Video 4

Video 5

Video 6

Video 7

Video 8

Video 9

Resim 1

Resim 2

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