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TCTAP C-134 Coronary Blowout Rupture Successfully Treated Using Two Guide Catheters
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
S255
We dilated the stents with non compliant balloons (SAPPHIRE NC Plus 2.5*12mm and NC TENKU 3.0*12mm). Because IVUS image revealed insufficient dilatation in proximal edge of stent, we dilated the point using NC TENKU 3.0*12mm with 22 atmosphere (atm). After then, the patient complained chest pain, and went into shock state. The angiogram showed blowout coronary perforation from LAD to pericardium. We compressed the perforation site by balloon inflation and succeed to stop bleeding. We also insert percutaneous pericardial drainage tube simultaneously. The patient’s hemodynamics could be stabilized. We inserted another guide catheter (7Fr. Launcher JL4.0) via right femoral artery and also crossed another guide wire (Asahi Sion Blue) to LAD. The ballon could be exchange to perfusion balloon (Ryusei) through the 2nd guide catheter with minimum balloon deflation time. Despite the long time balloon inflation, the bleeding could not be controlled. We thought covered stent (Graftmaster) was inevitable and implant it via the 1st guide catheter.
Case Summary. In this report, we considered that using the 4-mm goose neck snare with a smaller (5-Fr) catheter is feasible and effective for the retrieval of the severely kinked guide catheter and may contribute to the reduction of further vascular complications, particularly in patients with a diseased approach site. TCTAP C-134 Coronary Blowout Rupture Successfully Treated Using Two Guide Catheters Satoshi Yamamoto1 1 Chikamori Hospital, Japan [CLINICAL INFORMATION] Patient initials or identifier number. Y.Y. Relevant clinical history and physical exam. The patient was 70’s male. He had been taking an antihypertensive agent. He began to complain chest oppression on exertion for 2 months. His physician gave him a diagnosis of angina because of positive exercise stress electrocardiogram. The physician referred him to our hospital. Physical Exam Blood Pressure: 126/73mmHg, Heart Rate: 70bpm Cervical Bruits: Lung: clear, no rale Heart: S1/, S2/, S3-, S4-, no murmur Leg edema: Peripheral artery: well palpable Relevant test results prior to catheterization. 12 Leads electrocardiogram Heart Rate: 78bpm, Sinus Rhythm, Incomplete right bundle branch block Mild left ventricular hypertrophy with strain Chest Roentgenogram Cardio-thoracic Rate: 51% Congestion: Effusion: Echocardiogram No significant asynergy Relevant catheterization findings. Coronary Angiogram(CAG) Right Coronary Artery(RCA) #2: 50%, #4AV 50% Left Anterior Descending Artery(LAD) #7: 90% diffuse, #8 75% Left Circumflex Artery(LCX): #14 99% Left Ventriculogram(LVG): normal, Ejection Fraction(EF): 64% [INTERVENTIONAL MANAGEMENT] Procedural step. Right transradial approach Guide catheter: 6Fr. Launcher SL3.5 Guide wire: Asahi Route At first, we put a Xience Expedition stent (2.5:23mm) directly in LCX#14 and made kissing balloon technique to distal #13 branch. Then we moved to LAD intervention. After taking Intravascular Ultrasound (IVUS) image, we directly implanted two Xience Xpedition stents (2.25*23mm and 3.0*28mm) sequentially in LAD#8 and #7 with some overlapping.
S256
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
Case Summary. We successfully bailed out the perforation. And we could decrease the amount of bleeding using two guide catheters with minimizing the deflation time of compression devices. In this case, two guiding system was more useful because perfusion balloon and covered stent is very bulky device to handle with single 6Fr. guide catheter. TCTAP C-135 Rota Perforation 1
1
2
Yoichiro Matsuoka, Hiroyuki Onishi, Yasuhiro Kaetsu, Hiroaki Nakamura,1 Makoto Kadotani1 Kakogawa East City Hospital, Japan; 2Tottori University, Japan
1
[CLINICAL INFORMATION] Patient initials or identifier number. TK Relevant clinical history and physical exam. The patient was 73 year-old Male. He was previously hospitalized with burns. At that time, he received a coronary angiography preoperatively, and the three vessels disease with severe calcification was detected. He had never felt chest pain before. One day, he caused suddenly dyspnea during sleeping. Congestive heart failure was doubted, and he admitted to the hospital for inspection and treatment.
Relevant catheterization findings. Coronary angiogram was performed after congestive heart failure improvement. It revealed 90% stenosis with severe calcification lesions in the proximal RCA (#1-2), middle segment of LAD (#7).Chronic total occluded lesion was observed in the LCX (#13). We planned for PCI to RCA lesion because of LV inferior wall motion was decreased with viability positive. [INTERVENTIONAL MANAGEMENT] Procedural step. PCI for RCA was performed. The RCA severecalcification lesion was easily crossed with a hydrophilic soft guidewire. Numerousballoon catheters would not cross the lesion. The Tornus could not pass. We exchangedSion Blue to floppy type rotablation guidewire. After rotablation guidewire wascut and rota bar run out to the extra of coronary artery, an Ellis grade 2perforation appeared in the RCA #1. In order to occlude blood flow of theperforated site, We dilated the balloon with Ryusei 2.520mm (Perfusion balloon) at the perfusion site. TheRCA stenosis lesion was stented with a Xience alpine 3.533mm.
S255
We dilated the stents with non compliant balloons (SAPPHIRE NC Plus 2.5*12mm and NC TENKU 3.0*12mm). Because IVUS image revealed insufficient dilatation in proximal edge of stent, we dilated the point using NC TENKU 3.0*12mm with 22 atmosphere (atm). After then, the patient complained chest pain, and went into shock state. The angiogram showed blowout coronary perforation from LAD to pericardium. We compressed the perforation site by balloon inflation and succeed to stop bleeding. We also insert percutaneous pericardial drainage tube simultaneously. The patient’s hemodynamics could be stabilized. We inserted another guide catheter (7Fr. Launcher JL4.0) via right femoral artery and also crossed another guide wire (Asahi Sion Blue) to LAD. The ballon could be exchange to perfusion balloon (Ryusei) through the 2nd guide catheter with minimum balloon deflation time. Despite the long time balloon inflation, the bleeding could not be controlled. We thought covered stent (Graftmaster) was inevitable and implant it via the 1st guide catheter.
Case Summary. In this report, we considered that using the 4-mm goose neck snare with a smaller (5-Fr) catheter is feasible and effective for the retrieval of the severely kinked guide catheter and may contribute to the reduction of further vascular complications, particularly in patients with a diseased approach site. TCTAP C-134 Coronary Blowout Rupture Successfully Treated Using Two Guide Catheters Satoshi Yamamoto1 1 Chikamori Hospital, Japan [CLINICAL INFORMATION] Patient initials or identifier number. Y.Y. Relevant clinical history and physical exam. The patient was 70’s male. He had been taking an antihypertensive agent. He began to complain chest oppression on exertion for 2 months. His physician gave him a diagnosis of angina because of positive exercise stress electrocardiogram. The physician referred him to our hospital. Physical Exam Blood Pressure: 126/73mmHg, Heart Rate: 70bpm Cervical Bruits: Lung: clear, no rale Heart: S1/, S2/, S3-, S4-, no murmur Leg edema: Peripheral artery: well palpable Relevant test results prior to catheterization. 12 Leads electrocardiogram Heart Rate: 78bpm, Sinus Rhythm, Incomplete right bundle branch block Mild left ventricular hypertrophy with strain Chest Roentgenogram Cardio-thoracic Rate: 51% Congestion: Effusion: Echocardiogram No significant asynergy Relevant catheterization findings. Coronary Angiogram(CAG) Right Coronary Artery(RCA) #2: 50%, #4AV 50% Left Anterior Descending Artery(LAD) #7: 90% diffuse, #8 75% Left Circumflex Artery(LCX): #14 99% Left Ventriculogram(LVG): normal, Ejection Fraction(EF): 64% [INTERVENTIONAL MANAGEMENT] Procedural step. Right transradial approach Guide catheter: 6Fr. Launcher SL3.5 Guide wire: Asahi Route At first, we put a Xience Expedition stent (2.5:23mm) directly in LCX#14 and made kissing balloon technique to distal #13 branch. Then we moved to LAD intervention. After taking Intravascular Ultrasound (IVUS) image, we directly implanted two Xience Xpedition stents (2.25*23mm and 3.0*28mm) sequentially in LAD#8 and #7 with some overlapping.
S256
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
Case Summary. We successfully bailed out the perforation. And we could decrease the amount of bleeding using two guide catheters with minimizing the deflation time of compression devices. In this case, two guiding system was more useful because perfusion balloon and covered stent is very bulky device to handle with single 6Fr. guide catheter. TCTAP C-135 Rota Perforation 1
1
2
Yoichiro Matsuoka, Hiroyuki Onishi, Yasuhiro Kaetsu, Hiroaki Nakamura,1 Makoto Kadotani1 Kakogawa East City Hospital, Japan; 2Tottori University, Japan
1
[CLINICAL INFORMATION] Patient initials or identifier number. TK Relevant clinical history and physical exam. The patient was 73 year-old Male. He was previously hospitalized with burns. At that time, he received a coronary angiography preoperatively, and the three vessels disease with severe calcification was detected. He had never felt chest pain before. One day, he caused suddenly dyspnea during sleeping. Congestive heart failure was doubted, and he admitted to the hospital for inspection and treatment.
Relevant catheterization findings. Coronary angiogram was performed after congestive heart failure improvement. It revealed 90% stenosis with severe calcification lesions in the proximal RCA (#1-2), middle segment of LAD (#7).Chronic total occluded lesion was observed in the LCX (#13). We planned for PCI to RCA lesion because of LV inferior wall motion was decreased with viability positive. [INTERVENTIONAL MANAGEMENT] Procedural step. PCI for RCA was performed. The RCA severecalcification lesion was easily crossed with a hydrophilic soft guidewire. Numerousballoon catheters would not cross the lesion. The Tornus could not pass. We exchangedSion Blue to floppy type rotablation guidewire. After rotablation guidewire wascut and rota bar run out to the extra of coronary artery, an Ellis grade 2perforation appeared in the RCA #1. In order to occlude blood flow of theperforated site, We dilated the balloon with Ryusei 2.520mm (Perfusion balloon) at the perfusion site. TheRCA stenosis lesion was stented with a Xience alpine 3.533mm.