Lots of interesting abstracts and cases were submitted for TCTAP 2023. 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-128
A Case of Calcified RCA Complicated With Balloon Rupture and Trapped Balloon
By Ka Lung Chui
Presenter
Ka Lung Chui
Authors
Ka Lung Chui1
Affiliation
Prince Of Wales Hospital, Hong Kong, China1,
View Study Report
TCTAP C-128
CORONARY - Complications (Coronary)
A Case of Calcified RCA Complicated With Balloon Rupture and Trapped Balloon
Ka Lung Chui1
Prince Of Wales Hospital, Hong Kong, China1,
Clinical Information
Patient initials or Identifier Number
Miss C
Relevant Clinical History and Physical Exam
F/54, DM triopathy complicated with ESRF on peritoneal dialysis, severe peripheral artery disease with left foot gangrene
Admitted to hospital for acute coronary syndrome
PE Mild pallor, no murmur, chest clear, weak bilateral femoral pulses
hsTNT 800-900 (normal <14)
ECG showed T inversion over AVL only
Relevant Test Results Prior to Catheterization
Relevant Catheterization Findings
Coro showed LM mild disease, pLAD calcified 60-70%, LCx mild disease, ostial RCA 95% calcified, mRCA 80% calcified
8.mp4
7.mp4
4.mp4
8.mp4 7.mp4 4.mp4Interventional Management
Procedural Step
Failed to advance guide from femoral due to PVD
Deciced to switch to RRA with 7Fr sheath
IL3.5 as guiding
Wire to PDA with pilot 50 under turnipke LP, exchanged to runthrough EF
Predilated with 2.0mm NC balloon, 3.0mm NC balloon and then 3.5mm ShockWave
IVUS done, guided stenting to o-mRCA with Oynx 4.0 x38 mm DES and Oynx 4.0 x 18mm DES (with aid
of 6Fr Guideliner)
Post-dilated with 4.0mm NC balloon at high pressure
Noted balloon rupture during post-dilatation at oRCA (at 18atm)
Finally retrieve the balloon/wire/guideliner (whole system) with aid of 4Fr ST01
Rewire the RCA with JR4 guiding sionblack, failed to deliver IVUS
With aid of Sasuke dual lumen cathether, wire PLV with Runthrough EF
IVUS confirmed all wiring in true lumen and not under stent strut, but showed significant oRCA calcium
Further predilated oRCA with 6 runs of Shockwave 4.0 x 12mm at 6atm
Stented oRCA with Oynx 4.5 x 12mm DES at 18atm
Angiogram showed hazziness over pRCA
OCT and IVUS interrogation suggestive of balloon fragment left at pRCA stent segment-->decided for
externalisation with Oynx 4.0 x 18mm DES at 14atm
Excellent final angiographic and OCT results
TR band applied
11 strong pull.mp4
21 OCT.mp4
23.mp4
IMG001.mp4
oct_24 Oct 2022 17-47-23.mp4
Deciced to switch to RRA with 7Fr sheath
IL3.5 as guiding
Wire to PDA with pilot 50 under turnipke LP, exchanged to runthrough EF
Predilated with 2.0mm NC balloon, 3.0mm NC balloon and then 3.5mm ShockWave
IVUS done, guided stenting to o-mRCA with Oynx 4.0 x38 mm DES and Oynx 4.0 x 18mm DES (with aid
of 6Fr Guideliner)
Post-dilated with 4.0mm NC balloon at high pressure
Noted balloon rupture during post-dilatation at oRCA (at 18atm)
Finally retrieve the balloon/wire/guideliner (whole system) with aid of 4Fr ST01
Rewire the RCA with JR4 guiding sionblack, failed to deliver IVUS
With aid of Sasuke dual lumen cathether, wire PLV with Runthrough EF
IVUS confirmed all wiring in true lumen and not under stent strut, but showed significant oRCA calcium
Further predilated oRCA with 6 runs of Shockwave 4.0 x 12mm at 6atm
Stented oRCA with Oynx 4.5 x 12mm DES at 18atm
Angiogram showed hazziness over pRCA
OCT and IVUS interrogation suggestive of balloon fragment left at pRCA stent segment-->decided for
externalisation with Oynx 4.0 x 18mm DES at 14atm
Excellent final angiographic and OCT results
TR band applied
11 strong pull.mp4 21 OCT.mp4 23.mp4 IMG001.mp4 oct_24 Oct 2022 17-47-23.mp4Case Summary
This case illustrate how to manage trapped balloon and underexpansion in calcified lesion. Afterall, adequate lesion preparation is important in every calcified lesions, if the lesion is not fully prepared before stenting, it may result in an under-expanded stent. Shockwave balloon, although not optimal after stenting, can be used as bailout strategy to treat such calcified lesion after stenting too.