Collapse: Right Coronary Artery Chronic Total Occlusion Percutaneous Coronary Intervention with a Serious Complication
Presenter
Judit Karacsonyi, MD, PhD, Minneapolis Heart Institute® - Abbott Northwestern Hospital, Minneapolis, MN
Judit Karacsonyi, MD, PhD1, Raviteja Guddeti, MD2, Muhammad Hammadah, M.D.1 and Emmanouil S. Brilakis, MD, PhD, FSCAI1, (1)Minneapolis Heart Institute® - Abbott Northwestern Hospital, Minneapolis, MN, (2)-, Minneapolis, MN
Title:
Collapse: Right Coronary Artery Chronic Total Occlusion Percutaneous Coronary Intervention with a Serious Complication
Introduction:
Percutaneous coronary intervention was attempted in a 45-year old woman with medically refractory stable angina and right coronary artery (RCA) chronic total occlusion (CTO).
Clinical Case:
Engagement attempts of the RCA resulted in ostial dissection with failure of workhorse guidewires to enter into the true lumen, as confirmed by intravascular ultrasound (IVUS). Stingray-based re-entry also failed. True to true lumen retrograde crossing was achieved with a Sion Black guidewire, followed by ‘tip in’ using an antegrade Corsair microcatheter. After predilation, three drug eluting stents (DESs) were deployed and the posterolateral branch was recanalized using the STAR technique. When the last DES was positioned the patient became agitated and developed hypotension, followed by cardiac arrest. Cardiopulmonary resuscitation was performed with venoarterial extracorporeal membrane oxygenation (VA ECMO). Angiography demonstrated left main dissection that was treated with implantation of two DES restoring antegrade flow. The patient recovered and discharged home two weeks later with normal ejection fraction and no angina.
Discussion:
Donor vessel dissection and acute vessel closure can lead to fatal consequences. Mechanical circulatory support can stabilize the patients and allow definitive complication treatment.