Case 135: PCI Manual - Wiring challenges

An elderly woman presented with unstable angina and was found to have 2-vessel coronary artery disease with severe lesions in the LAD and the circumflex. PCI of the circumflex bifurcation lesion was successfully performed using the provisional technique. The LAD lesion was highly tortuous and calcified. Attempts to advance a workhorse guidewire through the LAD failed. Repeat attempts with a Sion black guidewire caused dissection with decreased antegrade flow. A Stingray balloon was used to re-enter into the distal true lumen using the “double blind stick and swap technique”. Stenting restored flow into the LAD but resulted in side branch occlusion (septal and diagonal) with persistent chest pain and cardiac biomarker elevation.

[shangz]

Thanks for the educative presentation.

[denizaktürk-jn]

Thank you very much for this educative presentation.

[Kulseref]

Dear dr. Brilakis, if we do not have stingray catheter, what we can do (except CABG)? Thank you

[rajmaster]

before balloon angioplasty how did you confirm you were in true lumen..?