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A case of percutaneous coronary intervention procedure successfully bailed out from multiple complications in

Yota Kawamura1, Masakazu Nagaoka, Daiki Ito

  • 1Cardiovascular center, Sagamihara kyodo Hospital, 2-8-18 Hashimoto, Midori-ku, Sagamihara, Kanagawa, Japan. youta@f4.dion.ne.jp

Cardiovascular Intervention and Therapeutics
|July 20, 2012
PubMed

Insights

This case report details complex percutaneous coronary intervention (PCI) challenges in a right coronary artery (RCA) with severe calcification. It highlights troubleshooting techniques for stent deployment and wire management during complex PCI.

Area of Science:

  • Interventional Cardiology
  • Cardiovascular Surgery
  • Medical Device Technology

Background:

  • A 73-year-old male with a history of coronary artery bypass grafting (CABG) presented with a calcified lesion in the right coronary artery (RCA).
  • Percutaneous coronary intervention (PCI) was planned for the complex lesion.
  • Previous CABG surgery can influence subsequent PCI strategies and outcomes.

Observation:

  • Initial attempts at stent implantation in the distal RCA using a child catheter resulted in device entrapment and stretching.
  • Difficulty in deploying a second stent in the mid-RCA due to severe calcification.
  • Accidental dislodgement of a stent from its balloon during attempted withdrawal.
  • Fracture of a guidewire tip during stent removal, requiring retrieval with a gooseneck snare.

Findings:

  • Successful stent implantation in the distal RCA after managing the entrapped child catheter.
  • Overcoming severe calcification in the mid-RCA using the buddy wire technique.
  • Managing stent dislodgement and guidewire fracture during the procedure.
  • Ultimately achieving successful stent placement in the mid and proximal RCA using the balloon anchor technique.

Implications:

  • Demonstrates the technical challenges and potential complications associated with complex PCI in heavily calcified coronary arteries.
  • Highlights the importance of advanced techniques and device manipulation for successful outcomes in challenging cases.
  • Provides insights into troubleshooting strategies for device entrapment, stent dislodgement, and guidewire issues during coronary interventions.

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