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CASE20191028_019
| CORONARY - Complications | |
| A Case of Coronary Perforation During Rotational Atherectomy | |
| Zhou Hao1, Changxi Chen1 | |
| The First Affiliated Hospital of Wenzhou Medical College, China1, | |
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[Clinical Information]
- Patient initials or identifier number:
cjd
-Relevant clinical history and physical exam:
clinical history: a male,61years, risk factors :hypertension ,smoking.He was admitted to our hospital for chest pain for 4days.physical exam:BP=157/73mmHg,HR=75bpm,No rale in both lungs,No heart murmur.-Relevant test results prior to catheterization:
test results:cTNI:9.8ug/L,Hb:141g/L,eGFR:124ml/min/1.73m2UCG:LVEDd:45mm,LVEF:49%- Relevant catheterization findings:
three vessel disease.diffuse stenotic lesions with an eccentric dense calcified plaque were detected in the proxmal andmid segment of the left anteriordescending (LAD) artery and left circumflex £¨LCX£© artery.
 00899196y.wmv 00899197y.wmv 00899198y.wmv |
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[Interventional Management]
- Procedural step:
The LAD proximal lesion was calcified and angulated.We believed that rotational atherectomy would be necessary due to calcification,An 7-Fr EBU3.5guide catheter was inserted via the right femoral artery. We advanced the rotational atherectomy burr 1.25 mm (160,000 rpm) to the calcified lesion , but coronary perforation happened. Immediate angiography evidenced a massive coronary perforation.The 2.5*15 quantum maverick balloon was deployed at12atm in the mid LAD to close the perforation.An 18-gauge 3.5-inch needle was attached to a 10ml-ml syringe and was advanced between the xiphoid process and left costal margin at 450, directed toward the left shoulder in the blind approach, 150ml of blood was aspirated. Covered stent was failed to deploy in the mid of LAD to cover the dissection,because of the high probability of deliver failure with severe angulation and calcification.But still in refractory hypotension and VT.Urgent coronary bypass surgery was done. Finally the patient became stable hemodynamics.
00899225y.wmv 00899271y.wmv 00899314y.wmv- Case Summary:
The risk of vessel perforation is greater in angulated calcified lesions during rotational atherectomy.The perforated segment cannot be treated percutaneously, seek to urgent coronary bypass surgery as soon as possible.
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