INTERESTING CASE OF KINKED GUIDING CATHETER COMPLICATED BY BRACHIOCEPH

Information about INTERESTING CASE OF KINKED GUIDING CATHETER COMPLICATED BY BRACHIOCEPH

Published on August 9, 2014

Author: leongwsan5

Source: authorstream.com

Content

INTERESTING CASE OF KINKED GUIDING CATHETER COMPLICATED BY RIGHT BRACHIOCEPHALIC ARTERY DISSECTION AND RIGHT RADIAL ARTERY SPASM : INTERESTING CASE OF KINKED GUIDING CATHETER COMPLICATED BY RIGHT BRACHIOCEPHALIC ARTERY DISSECTION AND RIGHT RADIAL ARTERY SPASM Dr Leong Weng San Cardiologist Hospital Raja Permaisuri Bainun Ipoh AFCC 2014 Sept 2013: Sept 2013 41 year old Indian gentleman Unstable angina Coros – transradial : 5Fr ortitorque 2VD – 1) Prox LAD CTO, collateral from RV branches 2) LCx –dominant :distal LCX 50% stenosis with TIMI 3 flow 3) RCA –recessive Planned staged PCI to LAD later but developed inferoposterior STEMI on 25 Jan 2014-successfully thrombolysed Recessive RCA –culprit? Likely LCX Coronary angiogram- not done Right radial approach No diagnostic catheter used 6Fr XB 3.5 guider AFCC 2014 Narrow aortic root. EBU 3.5 able to engage RCA but not LCA: Narrow aortic root. EBU 3.5 able to engage RCA but not LCA But, kinked noted : But, kinked noted Snaring from right femoral approach: Snaring from right femoral approach 7Fr right femoral sheath 7Fr JR 4.0 guiding catheter Multisnare 7 Fr JR 4.0 with multisnare: 7 Fr JR 4.0 with multisnare Unable to snare: Unable to snare 1) Wrong size of snare used –use smaller snare (goose-neck)- failed 2) Different dimension between both guider Dissection noted and Ostial Rt VA and RCC involved: Dissection noted and Ostial Rt VA and RCC involved What to do next: What to do next 1) Attempt wire from false lumen into true lumen 2) Snare the wire if able to penetrate into true lumen to straighten it –potential risk: worsening dissection, risk of closing supraaortic vessels 3) Pulling back as last resort –Risk : severe dissection of Rt Va, Rt CCA, Rt Ra Furthest I could go antegradely: Furthest I could go antegradely Terumo wire –baffling the ostials: Terumo wire –baffling the ostials Whats next: Whats next 1) second best place: straighten it or snare it at antecubetal fossa –failed 2) Entering retrograde terumo into kinked catheter –to make sure the terumo always in true lumen -better support to straighten the kinked catheter Antegrade reenter and Straightening the kinked catheter: Antegrade reenter and Straightening the kinked catheter Externalization of terumo: Externalization of terumo No flow at right radial artery even post Isoket: No flow at right radial artery even post Isoket Predilatation of right radial artery with Medtronic Invatec 6.0 x120mm at low pressure: Predilatation of right radial artery with Medtronic Invatec 6.0 x120mm at low pressure Reestablished right radial artery flow- no dissection: Reestablished right radial artery flow- no dissection Deploying self expanding stent: Deploying self expanding stent Deploying self expanding stent Medtronic Complete SE Ilaic 10 x40mm: Deploying self expanding stent Medtronic Complete SE Ilaic 10 x40mm Balloon Expandable stent Invatec Scuba 10 x37mm: Balloon Expandable stent Invatec Scuba 10 x37mm Final results: Final results Coronary: Coronary Successful PCI to LCX next day Successful antegrade PCI to Prox LAD CTO later

Related presentations


Other presentations created by leongwsan5