Скачать с ютуб Case 137: PCI Manual - Balloon uncrossable and balloon undilatable lesions в хорошем качестве

Case 137: PCI Manual - Balloon uncrossable and balloon undilatable lesions

An octogenarian presented with unstable angina and was found to have 3-vessel disease with multiple, severe heavily calcified LAD lesions along with aneurysmal dilations between lesions, ostial disease in a small circumflex and CTO of the mid RCA. He was turned down for CABG and was referred for PCI of the LAD. Wiring was very challenging due to lesion eccentricity, but was eventually successful using a Caravel microcatheter and a Suoh 03 guidewire. A 300 cm long Grand Slam wire was inserted to the distal LAD. We had difficulty advancing balloons to the mid LAD and also had multiple balloon ruptures. The proximal LAD lesion was balloon undilatable. We tried to re-insert the Caravel microcatheter and exchange for an atherectomy guidewire but it could not be advanced. We also failed to advance a Turnpike LP and a Telemark microcatheter. We eventually parallel wired to the distal LAD with Viper Flex Tip guidewire, removed the wire from the ramus and did multiple orbital atherectomy runs in the proximal and mid LAD. There was transient slow flow that improved with balloon angioplasty. Stents were implanted from the ostium to the mid LAD with an excellent result as confirmed by IVUS.