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Management of Critical RCA Lesion Complications: SCAI Summit Case Study

Learn techniques for handling high-risk scenarios like acute shock & perforation in a 71-year-old man with RCA blockages at the SCAI C3 Summit. Key points & interventions discussed.

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Management of Critical RCA Lesion Complications: SCAI Summit Case Study

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  1. 71 y.o. man with angina and CTO of the RCA • Stable angina class III • Inferior and lateral ischemia, preserved LVEF • PMH includes PVD, HTN, DM, Lipid disorder SCAI C3 Summit Chicago May 12-13, 2006 Dmitri Baklanov, Dartmouth

  2. 71 y.o. man with angina and CTO of the RCA

  3. Technique • Unilateral access • UF Heparin • 8F JR guide • Asahi MB3 wire

  4. 71 y.o. man with CTO of the RCA: Technique • Voyager 2.5/20 • Cypher stents 3.0/33 -distal • 3.5/33 -mid • 3.5/33 -prox • @ 15 atm • Powersail • 3.0/23 and 3.5/23 @ 22 atm SCAI C3 Summit Chicago May 12-13, 2006 Dmitri Baklanov, Dartmouth

  5. 71 y.o. man with angina and CTO of the RCA Patient develops shock

  6. 71 y.o. man with CTO of the RCA: Balloon occlusion, protamine SCAI C3 Summit Chicago May 12-13, 2006 Dmitri Baklanov, Dartmouth

  7. 71 y.o. man with free perforation of RCA: Pericardiocentesis and coated stent • Graftmaster • 3.5/16 • @21 atm SCAI C3 Summit Chicago May 12-13, 2006 Dmitri Baklanov, Dartmouth

  8. Final result (patient did well)

  9. Coronary perforation: Take Home Points • Low frequency event with high risk of mortality • Be ready to perform emergency pericardiocentesis • 8F guide is required for stent-graft placement • Contact blood bank for universal products STAT • Reversal of anticoagulation is important SCAI C3 Summit Chicago May 12-13, 2006 Dmitri Baklanov, Dartmouth

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