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TCTAP C-152 Ostial Stent Deformation by Wire Retrieval Within Engaged Guiding Catheter
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
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catastrophe. There was neither need of IABP or surgery needed. TAP technique gives wonderful results. TCTAP C-151 Successful Treatment of Type F Coronary Dissection Tsang-Wei Chang,1 Po-Kai Yang1 1 National Cheng Kung University Hospital, Taiwan [CLINICAL INFORMATION] Patient initials or identifier number. Mr. Chen Relevant clinical history and physical exam. A 53 y/o man, a heavy smoker, with hypertension, type 2 diabetes mellitus, presented with resting-onset and crescendo angina. Physical examination was unremarkable. Electrocardiography and chest X ray were also unremarkable. Relevant catheterization findings. Coronary angiography showed CAD/ 2VD (LAD and RCA). A 99% stenotic lesion at middle RCA with TIMI 2 flow was revealed, and we performed PCI for this RCA lesion. Predilation with a 4.0 mm x 20mm balloon under nominal pressure was done but followed angiography yielded no reflow. IVUS showed dissection and intramural hematoma. [INTERVENTIONAL MANAGEMENT] Procedural step. Buddy wire technique was applied to enhance support and prolonged balloon dilation was performed to regain flow. Yet, the RCA flow remained TIMI I. After we released the intramural hematoma by a 2.5mm x 10mm cutting balloon, we archived RCA TIMI III flow successfully. Then a 3.0mm x 30mm stent was deployed at the dissection site of middle RCA. Followed angiography showed TIMI 3 flow and chest discomfort was relieved. Cardiac catheterization will be performed with intralumen imaging device to evaluate the IMH.
Case Summary. Unpredictable event, such as coronary dissection, could occur during percutaneous coronary intervention. Although type F dissection carries increased morbidity and mortality, it could be well managed by an experienced team. TCTAP C-152 Ostial Stent Deformation by Wire Retrieval Within Engaged Guiding Catheter Chien-Lin Lee1 1 Far Eastern Memorial Hospital, Taiwan [CLINICAL INFORMATION] Patient initials or identifier number. Mr. Chen Relevant clinical history and physical exam. A 81-year-old male patient was a heavy smoker with history of chronic obstructive pulmonary
S276
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
disease (COPD). He had effort chest tightness and exertional dyspnea for months, which lasting for minutes and improved at rest. The chest tightness was in progression recently. His COPD status was relative stable and under regular inhalation therapy. There is no orthopnea, paroxysmal nocturnal dyspnea or leg edema. Physical examination was unremarkable. Relevant test results prior to catheterization. Thallium scan: (1) stress induced ischemia over inferior and lateral walls (2) moderate reduced LV contractility
Relevant catheterization findings. LM: calcified 40% stenosis LAD: ostium-proximal 70%, mid 70% stenosis LCX: proximal chronic total occlusion RCA: proximal chronic total occlusion [INTERVENTIONAL MANAGEMENT] Procedural step. We pass CTO lesion with Fielder FC under support of Corsair. Very long and diffuse lesion was noted after balloon dilation over CTO. We did 2-stenting over PDA/PLA bifurcation (TAP technique) and sequential stenting from distal RCA to RCA ostium. However, PDA wire is stuck after stenting and we have to forcefully retrieval of wire. Ostial stent is destroyed after removal of wire. Thus we have to pass wire from side of original stent, dilation of destroyed stent strut and deploy another stent to rescue RCA ostium.
Case Summary. We notice the ostial stent destruction after forcefully removal of stuck wire, and then successfully rescue RCA ostium with stenting from side strut of original stent. This complication is very rare and is due to combined situation including very stuck wire, stenting over RCA ostium and forcefully removal of wire with leverage inside RCA ostium stent. TCTAP C-153 Successfully Retrieval of Dislodged Stent in Deployed Stent in Long Diffuse Lesion You Chun Huang,1 I-Chung Chen,1 Chang-Chyi Lin2 1 Sijhih Cathay General Hospital, Taiwan; 2Cheng Hsin Rehabilitation Medical Center, Taiwan [CLINICAL INFORMATION] Patient initials or identifier number. Mr. Tsu, Male, 74 y/o Relevant clinical history and physical exam. Chief complaint: Syncope at bathroom with chest pain and shortness of breathiness.
S275
catastrophe. There was neither need of IABP or surgery needed. TAP technique gives wonderful results. TCTAP C-151 Successful Treatment of Type F Coronary Dissection Tsang-Wei Chang,1 Po-Kai Yang1 1 National Cheng Kung University Hospital, Taiwan [CLINICAL INFORMATION] Patient initials or identifier number. Mr. Chen Relevant clinical history and physical exam. A 53 y/o man, a heavy smoker, with hypertension, type 2 diabetes mellitus, presented with resting-onset and crescendo angina. Physical examination was unremarkable. Electrocardiography and chest X ray were also unremarkable. Relevant catheterization findings. Coronary angiography showed CAD/ 2VD (LAD and RCA). A 99% stenotic lesion at middle RCA with TIMI 2 flow was revealed, and we performed PCI for this RCA lesion. Predilation with a 4.0 mm x 20mm balloon under nominal pressure was done but followed angiography yielded no reflow. IVUS showed dissection and intramural hematoma. [INTERVENTIONAL MANAGEMENT] Procedural step. Buddy wire technique was applied to enhance support and prolonged balloon dilation was performed to regain flow. Yet, the RCA flow remained TIMI I. After we released the intramural hematoma by a 2.5mm x 10mm cutting balloon, we archived RCA TIMI III flow successfully. Then a 3.0mm x 30mm stent was deployed at the dissection site of middle RCA. Followed angiography showed TIMI 3 flow and chest discomfort was relieved. Cardiac catheterization will be performed with intralumen imaging device to evaluate the IMH.
Case Summary. Unpredictable event, such as coronary dissection, could occur during percutaneous coronary intervention. Although type F dissection carries increased morbidity and mortality, it could be well managed by an experienced team. TCTAP C-152 Ostial Stent Deformation by Wire Retrieval Within Engaged Guiding Catheter Chien-Lin Lee1 1 Far Eastern Memorial Hospital, Taiwan [CLINICAL INFORMATION] Patient initials or identifier number. Mr. Chen Relevant clinical history and physical exam. A 81-year-old male patient was a heavy smoker with history of chronic obstructive pulmonary
S276
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
disease (COPD). He had effort chest tightness and exertional dyspnea for months, which lasting for minutes and improved at rest. The chest tightness was in progression recently. His COPD status was relative stable and under regular inhalation therapy. There is no orthopnea, paroxysmal nocturnal dyspnea or leg edema. Physical examination was unremarkable. Relevant test results prior to catheterization. Thallium scan: (1) stress induced ischemia over inferior and lateral walls (2) moderate reduced LV contractility
Relevant catheterization findings. LM: calcified 40% stenosis LAD: ostium-proximal 70%, mid 70% stenosis LCX: proximal chronic total occlusion RCA: proximal chronic total occlusion [INTERVENTIONAL MANAGEMENT] Procedural step. We pass CTO lesion with Fielder FC under support of Corsair. Very long and diffuse lesion was noted after balloon dilation over CTO. We did 2-stenting over PDA/PLA bifurcation (TAP technique) and sequential stenting from distal RCA to RCA ostium. However, PDA wire is stuck after stenting and we have to forcefully retrieval of wire. Ostial stent is destroyed after removal of wire. Thus we have to pass wire from side of original stent, dilation of destroyed stent strut and deploy another stent to rescue RCA ostium.
Case Summary. We notice the ostial stent destruction after forcefully removal of stuck wire, and then successfully rescue RCA ostium with stenting from side strut of original stent. This complication is very rare and is due to combined situation including very stuck wire, stenting over RCA ostium and forcefully removal of wire with leverage inside RCA ostium stent. TCTAP C-153 Successfully Retrieval of Dislodged Stent in Deployed Stent in Long Diffuse Lesion You Chun Huang,1 I-Chung Chen,1 Chang-Chyi Lin2 1 Sijhih Cathay General Hospital, Taiwan; 2Cheng Hsin Rehabilitation Medical Center, Taiwan [CLINICAL INFORMATION] Patient initials or identifier number. Mr. Tsu, Male, 74 y/o Relevant clinical history and physical exam. Chief complaint: Syncope at bathroom with chest pain and shortness of breathiness.