Lots of interesting abstracts and cases were submitted for TCTAP 2022. Below are the accepted ones after a thorough review by our official reviewers. Don’t miss the opportunity to expand your knowledge and interact with authors as well as virtual participants by sharing your opinion in the comment section!
TCTAP C-104
My Worst Complication
By Seyedhossein Alavi
Presenter
Hosein Alavi
Authors
Seyedhossein Alavi1
Affiliation
Namazi, Iran1,
View Study Report
TCTAP C-104
CORONARY - Complications
My Worst Complication
Seyedhossein Alavi1
Namazi, Iran1,
Clinical Information
Patient initials or Identifier Number
239900
Relevant Clinical History and Physical Exam
A 67 years old gentleman man who presented with dyspnea on exertion. He had a history of PCI on RCA about 8 years ago. He was a smoker and had a history of chronic kidney disease. Physical examination was unremarkable.
Relevant Test Results Prior to Catheterization
ECG showed non specific ST-T change. CXR was normal.
Relevant Catheterization Findings
The LAD In left coronary angiogram was normal and LCX had severe stenosis. RCA was totally occluded due to instent CTO and filled distally via contralateral and bridging collaterals.
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Screen Recording 2021-11-12 at 9.37.19 AM.mov Screen Recording 2021-11-12 at 9.35.57 AM.movInterventional Management
Procedural Step
Due to CKD and high creatinine level we decided to do antegrade wire escalation without contralateral injection. After several attempts , Gaia guidewire with micro-catheter support passed CTO length but micro-catheter did not advance. Predilation with low profile balloon was performed and we changed the guidewire to BMW. Pre dilation with NC balloon for better preparation was done. Unfortunately we lost guidewire position . but guidewire was advanced easily with a loop shape into the distal branch that we think was PDA. unfortunately due to fear of increased contrast volume we implanted the stent in RV branch instead of PDA and perforation occurred. immediately the guidewire was recrossed and after pre dilation we decided to seal perforation with cover stent but cover stent was lost in the mid portion. because of limited time we crushed and trapped it with another DES and after post dilation eventually with guide extension cover stent was delivered and implanted. Due to hypotension Pericardiocentesis was done and finally stenting was performed with a good result.
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Screen Recording 2021-11-12 at 9.48.23 AM.mov Screen Recording 2021-11-12 at 9.51.14 AM.mov Screen Recording 2021-11-12 at 9.54.18 AM.mov Screen Recording 2021-11-12 at 9.58.25 AM.movCase Summary
The patient was a case of CKD and we used low volume contrast to minimize the damage to the kidney. But we were faced with a dangerous complication and it resulted in a perforation and stent loss.