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Lots of interesting abstracts and cases were submitted for TCTAP 2021 Virtual. Below are accepted ones after thoroughly reviewed by our official reviewers. Don’t miss the opportunity to explore your knowledge and interact with authors as well as virtual participants by sharing your opinion!

TCTAP C-068

Presenter

Satej Janorkar

Authors

Satej Sadashiv Janorkar1

Affiliation

Deenanath Mangeshkar Hospital & Research Center, India1,
View Study Report
TCTAP C-068
CORONARY - Complications

Percutaneous Coronary Intervention of a “Disappeared” Right Coronary Artery Caused Due to Iatrogenic Coronary Artery Dissection(ICAD): Importance of over the Wire Balloon System

Satej Sadashiv Janorkar1

Deenanath Mangeshkar Hospital & Research Center, India1,

Clinical Information

Patient initials or Identifier Number

J

Relevant Clinical History and Physical Exam

50-year-old female without any risk factors, presented with chronic stable angina. Increased in intensity for a month. Echocardiogram showed ST/Tchanges. 2D Echocardiography was Normal. Treadmill Test -Strongly positive. Body Surface Area 1.45 square metres. Biochemistry - Normal

Relevant Test Results Prior to Catheterization

Relevant Catheterization Findings

LM -Normal. LAD - calcified vessel. 90% in mid segment. LCX - 80% lesion after OM1. RCA - dominant. Ostial plaque. After 5-10 minutes patient experienced significant angina along with Hypotension. Monitor showed inferior wall ST/elevation. Check angio showed antegrade dissection which increased suddenly and became Type F dissection within seconds leading to acute closure of RCA. We planned to address ICAD immediately which proved to be extremely difficult.
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Interventional Management

Procedural Step

7 F JR4.0 guide catheter Launcher (Medtronics, USA) was advanced into right coronary sinus. Sinus injection was performed to check retrograde dissections if any. 0.014” BMW (Abbott,USA)wire was advanced through the guide catheter which kept on going into false lumen. This compelled us to advance another wire. 0.014” Whisper ES (Abbott, USA) wire was advanced through guide catheter along with 2.0 x 12 OTW balloon system (Abbott, USA). Whisper ES was advanced through true lumen using parallel wire technique. OTW system helped as additional support for the wire and also to administer contrast to confirm true lumen. Wire was exchanged to 0.014” BMW (Abbott, USA)through the same OTW system. 3 x 48 mm Xience Expedition (Abbott, USA) was advanced and deployed covering the entire length of the dissection in order to cover both exit points (Proximal at sinus and distal in distal segment). It was important to tackle distal exit point as well, since it may become entry point in some scenarios.
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Case Summary

ICAD during CAG is rare (<0.2%). Deep catheter intubation, manipulation, non-coaxial positioning of tip, forceful contrast injections may cause it. Guiding with a larger curve 4 - 4.5 is advisable. Sinus injection is imperative to check retrograde dissections if any. Hydrophilic wire with ES is useful to track the true lumen. OTW system can be used as an additional support for the wire and also to administer contrast to confirm true lumen while advancing the wire. OTW system helps to exchange the wires. Stenting of entire length of the dissection is advisable to cover both exit points (proximal at sinus and distal in distal segment). Surgeon backup is required.

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