Case 130: PCI Manual - ST elevation resolution

A patient presented with inferior STEMI. Diagnostic angiography showed a 90% mid RCA lesion and a 90% lesion in what appeared to be the right PDA. There was TIMI 3 flow through both lesions. The RCA was successfully stented, but ST segment elevation and chest pain continued. A wire was advanced aiming to wire the inferior branch with the 90% lesion, but it entered a more proximal branch that was actually the PDA that had been occluded at the ostium. Antegrade flow was restored into the PDA with resolution of the chest pain and the ST segment elevation.

[tom]

Nice case, a flush occluded pda that can be overseen even be experienced operator

[doctorcardio]

The initial rca injection was an Lao view .an ap cranial or lao cranial injection is indicated in a dominant rca and would possibly have given some clue about the occlusion.

[Batette]

Prof. Brilakis, how exactly was your technique with the PDA? It was not a crush, right? Did you place the stent with a little Protrusion, wired through the struts that protruded and modeled them onto the main vessel? Would there not be a Kissing necessary?

[zerjo]

Why do not use a drug coated ballon for the small branch instead of just ballon angioplasty ?

[BahadirSimsekMD]

Awesome! Thanks for sharing, Dr. Brilakis!

[shangz]

Thanks for the educative case sharing.