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Stable angina class III

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. 71 y.o. man with angina and CTO of the RCA. Technique. Unilateral access. UF Heparin. 8F JR guide. Asahi MB3 wire.

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Stable angina class III

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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

  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

  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

  7. 71 y.o. man with free perforation of RCA: Pericardiocentesis and coated stent • Graftmaster • 3.5/16 • @21 atm

  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

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