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TCTAP C-108

Coronary Artery Perforation Successfully Treated With a Stent Graft and Second Drug-Eluting Stent

By Chanikarn Kanaderm

Presenter

Chanikarn Kanaderm

Authors

Chanikarn Kanaderm1

Affiliation

Central Chest Institute of Thailand, Thailand1,
View Study Report
TCTAP C-108
Coronary - Complication Management

Coronary Artery Perforation Successfully Treated With a Stent Graft and Second Drug-Eluting Stent

Chanikarn Kanaderm1

Central Chest Institute of Thailand, Thailand1,

Clinical Information

Patient initials or Identifier Number

Relevant Clinical History and Physical Exam

A Thai female 84 years old,denied underlying disease (never check up).Presented withretrosternal chest pain 2hours PTA• Initial vital signs : BP 100/60, HR 75/min, RR 20/min Physical exam : good consciousness, JVP not engorged, normal s1s2, no murmur,normal breath sounds, no pitting edema

Relevant Test Results Prior to Catheterization

ECG 12 leads : ST elevation in II, III, aVF and depression in lead I, aVL.CXR : Marked cardiomegaly.Echocardiography : Poor LV systolic function EF 18%  with inferior and inferoseptal wall hypokinesia.


Relevant Catheterization Findings

LM : normalLAD : 90% proximal LAD: stenosis,Non significant DG and septalbranch LCX : non significant RCA : 95% stenosis of proximal RCAwith filling defect


Interventional Management

Procedural Step

Primary PCI to RCAGD : Launcher SAL 1.0GW Wire : SION and Run through NS Hypercoat Balloon (Sprinter legend 2.0*12 mm) wasinflated at distal RCA (12 atm) and proximalRCA (12 atm) Stents :- Biometrix Alpha 2.5*36 mm at pRCA- Firehawk 3.0*13 mm at ostial RCA- Biometrix Alpha 3.0*9 mm at ostial RCAThe angiogram show perforation ostial RCA.Management for ostial RCA perforation Balloon Tasuki 4.0 * 8 mm (18 atm)- Stent graft PK papyrus 3.5 * 15 mm(16 atm)Post dilated with- Tasuki 3.0 * 21 mm, inflated at p-mRCA (20 atm) and at ostial RCA (20 atm)- Tasuki 4.0 * 8 mm at ostial RCA (18atm)- NC Trek 4.5 * 8 mm at ostial RCA (16atm)Stent : the 5th stent (Biometrix Alpha4.0*9 mm, 14 atm) at ostial RCABalloon NC Trek 4.5 * 8 mm (18 atm)The final angiogram show no residual leakage.


Case Summary

-Gentle manipulate when use extra support guiding .-Utilization of Sepal technique to prevent trauma from tip of catheter and precise for stent at ostial RCA .-Difficult differential diagnosis between aorto-ostial dissection and ostial perforation.-The stent graft will help in perforation situation.-The second DES may be help if the leakage still continue.